Does early catheter ablation (<1 year) reduce atrial fibrillation recurrence compared with delayed ablation: A systematic review and meta-analysis

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Catheter ablation (CA) is an effective therapy for symptomatic AF. Emerging evidence indicates that early CA may attenuate disease progression and reduce major adverse cardiovascular and cerebrovascular events (MACCE). There is a lack of high-quality pooled data comparing clinical outcomes of early versus delayed CA using a standardized diagnosis-to-ablation time. This meta-analysis evaluates whether early CA (<12 months) versus delayed CA (>12 months) after AF diagnosis is linked to differences in clinical outcomes, including AF/atrial arrhythmia recurrence, mortality, AF-related hospitalization, and MACCE. Methods A systematic literature search of PubMed, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials and observational cohort studies until December 1, 2025, was conducted. The primary outcome was AF recurrence. Results A total of 10 studies including 22,748 patients were analyzed. For the primary outcome, early CA (<12 months) was associated with a significantly lower risk of AF recurrence compared with delayed ablation (>12 months) (RR 0.69; 95% CI, 0.54–0.88; p = 0.007, I2 = 92). Subgroup analyses suggested a consistent benefit in persistent AF populations. For secondary outcomes, early ablation was associated with a reduced risk of AF-related hospitalization (RR 0.58; 95% CI 0.39–0.86; p = 0.04; I2 = 0%) and repeat electrical cardioversion (RR 0.66; 95% CI 0.48–0.91; p = 0.03; I2 = 34%). No significant differences were observed for all-cause mortality, repeat ablation, MACCE, cardiovascular hospitalization, antiarrhythmic drug use, stroke/transient ischemic attack, or all-cause hospitalization. Conclusion Early CA (<12 months) was associated with significantly lower rates of AF recurrence, electrical cardioversion, and AF-related hospitalizations compared with delayed CA (>12 months). Future randomized controlled trials are needed to evaluate potential long-term benefits and to identify patient subgroups most likely to benefit from early CA. © 2026 Elsevier Ltd.