Key result
Catheter ablation for AF in HFpEF yields similar arrhythmia recurrence to HFrEF or no HF.
Why the study?
Catheter ablation for AF is proven in HFrEF, but whether outcomes differ in patients with HFpEF remains of interest.
Does catheter ablation for atrial fibrillation improve outcomes in patients with HFpEF compared to those with HFrEF or without heart failure?
Meta-Analysis (n=2,554)
Does catheter ablation for atrial fibrillation improve outcomes in patients with HFpEF compared to those with HFrEF or without heart failure?
Catheter ablation for AF in patients with HFpEF appears to have similar efficacy and safety outcomes as in patients with HFrEF or without heart failure, based on observational data.
Supports comparable ablation efficacy in HFpEF; extends observational data but leaves open randomized outcome trials.
Background: Catheter ablation for atrial fibrillation (AF) is a proven alternative to pharmacologic rhythm control in patients with heart failure with reduced ejection fraction (HFrEF). Whether outcomes differ in patients with heart failure with preserved ejection fraction (HFpEF) is of interest. Methods: Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary efficacy outcomes of interest include atrial arrythmia recurrence and repeat ablation. Harm outcomes of interest include all-cause mortality, all-cause hospitalizations, cardiovascular hospitalizations, stroke/transient ischemic attack, and cardiac tamponade. Results: We included 7 observational studies comprising 2554 patients with HFpEF who underwent catheter ablation for AF. When comparing patients with HFpEF versus without HF, there was no significant difference in atrial arrhythmia recurrence (risk ratio [RR] 1.39; 95% confidence interval [CI] 0.91-2.13), stroke or transient ischemic attack (TIA) (RR 0.47; 95% CI 0.03-6.54), or cardiac tamponade (RR 1.20; 95% CI 0.12-12.20). When comparing patients with HFpEF versus HFrEF, there was no significant difference in atrial arrhythmia recurrence (RR 1.12; 95% CI 0.92-1.37), repeat ablation (RR 1.19; 95% CI 0.74-1.93), all-cause mortality (RR 0.87; 95% CI 0.67-1.13), all-cause hospitalizations (RR 1.10; 95% CI 0.94-1.30), cardiovascular hospitalizations (RR 0.83; 95% CI 0.69-1.01), stroke or TIA (RR 0.81; 95% CI 0.29-2.25), or cardiac tamponade (RR 0.98; 95% CI 0.19-5.16). Conclusions: Non-randomized studies suggest that catheter ablation for AF in patients with HFpEF is associated with similar arrythmia-free survival and safety profile when compared to patients with HFrEF or without heart failure.
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Siddiqui et al. (2022) conducted a meta-analysis in Atrial fibrillation and heart failure with preserved ejection fraction (n=2,554). Catheter ablation vs. Patients with HFrEF or without heart failure was evaluated on Atrial arrhythmia recurrence (HFpEF vs HFrEF) (RR 1.12, 95% CI 0.92-1.37). Catheter ablation for AF in HFpEF showed similar arrhythmia recurrence compared to patients with HFrEF (RR 1.12; 95% CI 0.92-1.37) or without HF (RR 1.39; 95% CI 0.91-2.13).
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