Arrhythmia recurrence following catheter ablation for atrial fibrillation (AF) remains a key limitation to long-term procedural success. A meta-analysis published in Heart Rhythm evaluated baseline clinical risk factors associated with post-ablation recurrence and their consistency across AF phenotypes.

Eight databases were systematically searched through December 2025, including 152 prospective cohort studies comprising 49,919 patients. Study quality was assessed using the Newcastle-Ottawa scale, and pooled multivariable-adjusted hazard ratios (aHRs) were estimated using random-effects models.

Sixteen clinical risk factors were identified. The strongest associations with recurrence were observed for smoking (aHR 2.15 [95% CI 1.49–3.10]), periodontitis (aHR 2.04 [1.48-2.83]), metabolic syndrome (aHR 1.71 [1.12–2.62]), sleep apnea (aHR 1.65 [1.31-2.09]), and persistent AF (aHR 1.64 [1.53-1.76]).

Additional associated factors included chronic kidney disease, alcohol consumption, overweight or obesity, diabetes mellitus, female sex, hypertension, AF history, left atrial enlargement, and reduced left ventricular ejection fraction. Untreated sleep apnea (aHR 2.41 [1.51-3.86]) and uncontrolled hypertension (aHR 1.67 [1.12-2.40]) were associated with higher recurrence risk.

Sensitivity analyses using adjusted odds ratios identified depression (aOR 2.86 [1.51-5.41]) and anxiety (aOR 2.54 [1.59-4.04]) as additional correlates. Subgroup analyses showed consistent associations across AF phenotypes, while meta-regression identified ablation modality and geographic region as sources of heterogeneity. These findings outline a broad clinical risk profile for AF recurrence following ablation.