Catheter ablation in patients with atrial fibrillation and cancer: a systematic review and updated meta-analysis

Abstract

Background: Atrial fibrillation (AF) is common in cancer patients, and catheter ablation (CA) is a treatment option. However, outcomes of CA in cancer patients remain unclear.

Objectives: To evaluate the outcomes of CA for AF in patients with a current or previous history of cancer compared to those without cancer, primarily focusing on bleeding, arrhythmia recurrence, repeat ablation, and mortality.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. Data on bleeding, AF recurrence, repeat ablation, and mortality were pooled. Sensitivity analyses, meta-regression, and subgroup analyses explored factors influencing outcomes.

Results: There were no randomized controlled trials (RCT). We included eight observational studies with 69,819 patients, of whom 68,913 were included in the primary outcome analysis. There was a non-significant trend toward increased clinically relevant bleeding within three months after CA in cancer patients compared to those without cancer (4.9% vs. 3.3%; OR 1.57; 95% CI 0.99-2.51; p = 0.056; I² = 24.1%). No significant differences were found in AF recurrence, the need for repeat ablation within 1 year, or mortality. Meta-regression indicated that prior oral anticoagulant use was not associated with a higher bleeding risk, while increasing age was associated with a higher risk of arrhythmia recurrence.

Conclusions: Compared to patients without cancer, CA for AF in cancer patients shows a trend toward higher bleeding risk, without statistical significance. RCT focused on cancer patients are needed to assess the safety and efficacy of AF treatments in this high-risk population.

Keywords: Atrial Fibrillation; Bleeding; Catheter Ablation; Mortality; Neoplasms.