Association Between Success Rate and Citation Count of Studies of Radiofrequency Catheter Ablation for Atrial Fibrillation: Possible Evidence of Citation Bias

Study Questions:

Is there citation bias among studies that have evaluated the efficacy of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?


One hundred seventy-four studies that reported on the efficacy of RFCA of AF between 1990 and 2012 were analyzed for multiple variables including sample size, study design, reported efficacy, journal impact factor, and authorship. The primary outcome of the study was the number of times that each of these studies was cited in subsequent publications.


The reported success rates ranged from 10% to 92% after a single procedure and 31% to 95% after multiple procedures. The mean citation count was approximately 54. After adjustment for time since publication, a 10-point increase in the reported success rate was associated with a 17.8% increase in the number of times the article was cited. This association was found to be independent of possible confounding variables such as journal impact factor and authorship by an acknowledged expert in the field.


Studies that have reported higher success rates for RFCA of AF are more likely to be cited than studies that have cited lower success rates.


This interesting study demonstrates that citation bias can exaggerate the perceived efficacy of RFCA of AF. However, there are important potential confounding variables that were not included in the analysis, including scientific quality, type of patient population, and ablation strategy. Whether the association between reported efficacy and citation count would remain just as strong after correction for these variables is unclear.

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