Anxiety is associated with higher recurrence of atrial fibrillation after catheter ablation: A meta-analysis

Previous studies that evaluated the influence of anxiety on recurrence of atrial fibrillation (AF) after catheter ablation showed inconsistent results. We performed a meta-analysis of cohort study to systematically evaluate the association between anxiety and AF recurrence after catheter ablation. Electronic databases of PubMed, Embase, and Web of Science were searched for relevant cohort studies from inception to January 20, 2021. We applied the random-effect model to combine the results to incorporate the potential influence of heterogeneity among studies. Five cohort studies were eligible for the meta-analysis, which included 549 patients with AF that received catheter ablation. No significant heterogeneity was observed among the included studies (I-2 = 7%, P for Cochrane's Q test = 0.37). During a mean follow-up of 9.7 months, 216 (39.3%) cases of recurrent AF occurred. Results of the meta-analysis showed that anxiety was independently associated with an increased risk of AF recurrence after catheter ablation (adjusted relative risk: 2.36, 95% confidence interval: 1.71-3.26; p < .001). Subgroup analyses did not show that differences in study characteristics including study design, ethnicity of the patients, sample size, AF type, anxiety evaluation method, follow-up duration, or adjustment of LAD may significantly affect the association between anxiety and AF recurrence (p for subgroup difference all > .10). Anxiety may be an independent risk factor for AF recurrence after catheter ablation. Whether alleviating anxiety mood could reduce the risk of AF recurrence after catheter ablation should also be investigated.