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

Background 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. Methods 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. Results 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 mm 2 ; 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. Conclusion 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.