Prospective observational study of the effect of catheter ablation among patients with heart failure with preserved ejection fraction and persistent atrial fibrillation: Findings from BENEFIT-HFpEF

Catheter ablation (CA) is beneficial in patients with heart failure with reduced ejection fraction and atrial fibrillation (AF), but its role in heart failure with preserved ejection fraction (HFpEF) remains unclear. The BENEFIT-HFpEF study prospectively evaluated CA in patients with HFpEF and persistent AF. This multicenter prospective study enrolled 55 patients with HFpEF (left ventricular ejection fraction ≥ 45%, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and structural heart disease) and persistent or long-standing persistent AF. All the patients underwent pulmonary vein isolation. The primary endpoint, change in peak VO₂ at 6 months, showed no significant improvement (median 15.9 to 15.9 mL/min/kg). However, secondary outcomes improved: NYHA class decreased, Minnesota Living with Heart Failure Questionnaire scores declined (median 13 to 6), VE/VCO₂ slope improved (median 35.2 to 31.7), and NT-proBNP levels dropped markedly (median 1354 to 281 pg/mL); nonetheless, 47.2% of patients still had NT-proBNP ≥ 300 pg/mL. Echocardiography showed left atrium reverse remodeling, with the left atrial volume index decreasing from a median of 44.1 to 27.6 mL/m²; 33% still had left atrial enlargement. Sinus rhythm was maintained in 94.3 and 96.0% at 6 and 12 months, respectively. No deaths or heart failure hospitalizations occurred during follow-up; AF recurrence rate was 20.0% at 12 months. In HFpEF with persistent AF, CA improved symptoms, cardiac structure, and natriuretic peptide levels. Signs of ongoing HFpEF pathology remain in many patients even after CA. Further randomized trials are needed to evaluate long-term outcomes.