Abstract 14691: Safety and Efficacy of Catheter Ablation for Atrial Fibrillation in Patients With a History of Cancer: A Systematic Review and Meta-Analysis

Background: Patients with an active or past medical history of cancer have an increased risk of atrial fibrillation (AF) and drug-refractory AF. However, evidence for the safety and efficacy of catheter ablation in this population remains limited.

Hypothesis: Catheter ablation is a safe and effective strategy for rhythm control in cancer survivors with AF.

Aims: To perform a systematic analysis of published studies comparing the safety and efficacy of AF catheter ablation in persons with and without prior or active cancer.

Methods: We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of AF catheter ablation in persons with and without cancer. Outcomes of interest were bleeding events, recurrence of AF after 12 months, and the need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1.

Results: We included five retrospective cohort studies comprising 998 patients, of whom 413 (41.4%) had a history of cancer diagnosis, including 58 (14%) with active cancer at the time of catheter ablation. Patients with a diagnosis of cancer had at significantly higher risk of clinically relevant bleeding (OR 2.07; 95% CI 1.03-4.15; p=0.04; Figure 1A) compared to those without cancer. Recurrence of AF after 12 months (OR 1.26; 95% CI 0.81-1.96; p=0.31; Figure 1B) and the need for repeat ablation did not differ significantly between groups (OR 0.71; 95% CI 0.37-1.37; p=0.31), respectively.

Conclusions: The findings from our meta-analysis suggest that patients with a history of cancer have an increased risk of bleeding after AF catheter ablation compared to patients without cancer, with no significant differences in the efficacy of the catheter ablation between patients with or without cancer.