Long-term outcome of patients with atrial fibrillation and heart failure with preserved ejection fraction after combined radiofrequency catheter ablation and left atrial appendage closure

Background In patients with heart failure with preserved ejection fraction (HFpEF), further investigation of the safety and long-term efficacy of combined radiofrequency catheter ablation and left atrial appendage closure (RF + LAAC) in patients with HFpEF is warranted. Methods In this retrospective study, we aimed to evaluate the outcome of RF + LAAC in patients with AF and HFpEF, compared to radiofrequency catheter ablation (RF) alone. 331 patients with AF and chronic HFpEF were divided into two groups: RF + LAAC ( n = 196) and RF ( n = 135). After 1:1 propensity score matching (PSM), 96 matched pairs were enrolled in further analysis. HF rehospitalization, ischemic stroke/transient ischemic attack (TIA), and major bleeding events were assessed over 24 months. Kaplan–Meier analyses were used to compare outcomes. Results The RF + LAAC group demonstrated comparable procedural complication rates to RF alone (5.2% vs. 4.2%, p = 0.733). The risks of ischemic stroke/TIA (ARR=4.95%, HR = 0.096, 95%CI:0.012–0.753, p = 0.026) and major bleeding events (ARR=3.91%, HR = 0.120, 95%CI: 0.015–0.957, p = 0.045) were significantly lower in RF + LAAC group vs. RF alone, while HF rehospitalization was similar between the two groups (ARR=−0.56%, HR = 1.356, 95%CI: 0.303–6.059, p = 0.690). Conclusions In patients with AF and HFpEF, combined RF + LAAC was associated with lower risks of ischemic stroke/TIA and major bleeding, without an observed increase in HF rehospitalization, compared with RF alone.