Clinical Burden of Post-ablation Atrial Fibrillation Recurrence in East Asia: A Systematic Literature Review.

Aim: This study aimed to systematically review and synthesise existing real-world evidence on the clinical characteristics and outcomes of patients with post-ablation AF recurrence in east Asia. Methods: Following the PRISMA guidelines, main Chinese- and English-language databases were searched for observational studies published from 2019 to 2024. Inclusion criteria targeted East Asian patients aged ≥18 years with post-ablation AF recurrence. Two independent reviewers conducted study selection, data extraction and quality assessment using the Newcastle-Ottawa Scale. Meta-analyses were performed using a random effects model to synthesise the extracted data. Results: A total of 68 studies involving 28,750 patients were included. Paroxysmal AF accounted for about half of the population (53.4%; 95% CI [47.8-58.9]). Common comorbidities included hypertension (52.6%; 95% CI [50.2-55.0]), coronary artery disease (17.2%; 95% CI [12.9-22.5]) and diabetes (16.8%; 95% CI [14.9-18.8]). The AF recurrence rates after repeat ablation (21.4%; 95% CI [16.6-27.1]) and antiarrhythmic drug therapy (19.6%; 95% CI [18.0-21.2]) were similar. Recurrence was higher in patients with late recurrence (32.6%; 95% CI [26.9-38.8]) than those with early recurrence (21.5%; 95% CI [17.9-25.6]). The pooled 3-year incidence of major events included heart failure hospitalisation (3.2%; 95% CI [2.8-3.6]), ischaemic stroke (1.2%; 95% CI [0.9-1.7]) and cardiovascular-related death (0.3%; 95% CI [0.1-0.5]). Conclusion: Post-ablation AF recurrence in East Asia imposes a considerable disease burden with high recurrence rates even after repeated ablation or antiarrhythmic drug therapy. The presence of prevalent comorbidities and measurable risks of morbidity and mortality further contribute to the long-term clinical and economic burdens of AF.