Long-Term Outcomes of Catheter Ablation in Heart Failure With Reduced Ejection Fraction Patients With Atrial Fibrillation.

While catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF), its impact on long-term clinical outcomes in patients with concomitant heart failure with reduced ejection fraction (HFrEF) remains uncertain. This study aimed to evaluate the clinical outcomes of CA versus conventional therapy in patients with HFrEF and AF. We utilized data from the TriNetX US Collaborative Network (January 2014-December 2024) with a 3-year follow-up period. Patients aged ≥18 years with HFrEF (EF < 40%) and AF were categorized into two cohorts: those received CA versus conventional therapy. Propensity score matching was performed to minimize selection bias. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization, recurrent AF, and heart failure (HF) hospitalization. After propensity score matching, 64,743 patients remained in each cohort. The mean age was 73.4 ± 11.4 years in the CA cohort and 73.5 ± 11.5 years in the control cohort (p = 0.109). CA was associated with reduced all-cause mortality (HR = 0.46, 95% CI: 0.43-0.49, p < 0.001), all-cause hospitalization (HR = 0.94, 95% CI: 0.92-0.95, p < 0.001) and recurrent AF (HR = 0.80, 95% CI: 0.79-0.82, p < 0.001) but higher HF hospitalization (HR = 1.07, 95% CI: 1.06-1.08, p < 0.001) compared to conventional therapy. Our study demonstrated that in patients with AF and HFrEF, CA was associated with significantly reduced all-cause mortality, all-cause hospitalization, and AF recurrence, but an increased risk of HF hospitalization compared to conventional therapy. These findings suggest that CA may provide substantial long-term benefits in this high-risk population, while highlighting the importance of careful patient selection and post-procedural management.