Perino AC, et al. - This systematic review and meta-analysis of 180 trials and observational studies with 28,118 patients meeting inclusion, was performed from January 1, 1990, to August 1, 2016, to characterize secular trends in atrial fibrillation (AF) ablation success rates. PubMed, Scopus, and Cochrane databases were used to identify the relevant studies, excluding those with insufficient outcome reporting and ablation strategies that were not prespecified and uniform. Multivariate meta-regressions were used. Treatment arms were stratified by AF type (paroxysmal AF; nonparoxysmal AF) and single-procedure outcomes were analyzed. Range of unadjusted success rate summary estimates was from 73.1% in 2003 to 77.1% in 2016, increasing by 0.9%/year, for paroxysmal AF ablation studies, while unadjusted success rate summary estimates ranged from 70.0% in 2010 to 64.3% in 2016 for nonparoxysmal AF ablation studies, with no improvement seen in multivariate analyses. Incremental improvements in success rates have been reported. Major paradigm or technology changes as well as evaluation of clinical outcomes may be useful.