# Relationship between periodontitis and atrial fibrillation recurrence after ablation: a systematic review

## TL;DR

This review finds that periodontitis is linked to a higher risk of atrial fibrillation recurrence after ablation, possibly due to systemic inflammation and oral bacteria.

## Contribution

This is the first systematic review to investigate the relationship between periodontitis and AF recurrence after ablation.

## Key findings

- Periodontitis was associated with increased AF recurrence risk, with hazard ratios ranging from 1.57 to 2.31.
- Systemic inflammation markers like CRP, IL-6, and TNF-α were implicated in the mechanism linking periodontitis to AF recurrence.
- Periodontitis is suggested as a modifiable risk factor for AF recurrence after ablation.

## Abstract

Atrial fibrillation (AF) recurrence after catheter ablation remains a significant clinical challenge, with chronic inflammation implicated in its pathogenesis. Periodontitis, a prevalent chronic inflammatory disease, may contribute to AF recurrence through systemic inflammation and microbial translocation. This systematic review synthesizes evidence on the association between periodontitis and AF recurrence post-ablation.

MEDLINE, EMBASE, and Cochrane Library were searched from inception to January 2026. Observational studies evaluating periodontitis (diagnosed clinically, serologically, or via periodontal indices) and post-ablation AF recurrence in adults were included. Study quality was assessed using the Newcastle-Ottawa Scale. Narrative synthesis was performed due to methodological heterogeneity.

Three observational studies (n = 1,016 patients) met inclusion criteria. Periodontitis prevalence ranged from 54% to 57%. All studies reported significant associations between periodontitis and increased AF recurrence risk, including elevated Porphyromonas gingivalis antibodies [paroxysmal AF: hazard ratio (HR) = 1.57; 95% confidence interval (CI), 1.01–2.43; non-paroxysmal AF: HR = 1.91; 95% CI, 1.21–3.01], clinical periodontitis (HR = 2.06, 95% CI, 1.02–4.18), and high Periodontal Inflamed Surface Area (PISA >615 mm2; HR = 2.31, 95% CI, 1.23–4.32). Mechanistically, systemic inflammation, reflected by elevated C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and pathogen-specific atrial remodeling were implicated.

Periodontitis is consistently associated with higher AF recurrence after ablation, likely mediated by systemic inflammation and oral pathogen activity, highlighting periodontitis as a modifiable risk factor for AF recurrence.