Smoking and Risk of Atrial Fibrillation Recurrence After Catheter Ablation: A Meta-Analysis and Meta-Regression

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. Although catheter ablation is an established rhythm-control strategy, recurrence remains frequent. Smoking is a potentially modifiable risk factor, but its impact on post-ablation AF recurrence remains uncertain. This study evaluated the association between smoking status and AF recurrence following catheter ablation.

Six databases were searched up to March 2026. Studies including patients with AF undergoing first-time catheter ablation and reporting recurrence outcomes stratified by smoking status were included. Sensitivity, subgroup, and meta-regression analyses were performed. Publication bias was evaluated using Egger's test and trim-and-fill analysis.

Twenty-two studies comprising 6047 participants were included. Smoking was associated with a significantly increased risk of AF recurrence following catheter ablation (OR 1.42, 95% CI: 1.09-1.85; p = 0.0096), with substantial heterogeneity (I ² = 65.8%). Sensitivity analysis confirmed the robustness of the findings (OR 1.35, 95% CI: 1.05-1.73). No significant small-study effects were detected (Egger's p = 0.4280), although trim-and-fill analysis attenuated the association to borderline significance. Meta-regression identified body mass index (BMI) as a significant moderator, with a weaker association observed in populations with higher BMI.

Smoking is associated with a modest but significant increase in the risk of AF recurrence after catheter ablation. Future studies should evaluate the impact of smoking intensity, duration, and cessation on ablation outcomes using patient-level data.