Timing of Catheter Ablation After Heart Failure Diagnosis for Atrial Fibrillation: A Propensity‐Score‐Matched Analysis

BACKGROUND: Catheter ablation improves outcomes in patients with atrial fibrillation (AF) and heart failure (HF). However, most of the evidence on the importance of ablation timing has been anchored to AF rather than HF onset, leaving the optimal interval between HF diagnosis and ablation incompletely defined. OBJECTIVES: To evaluate the association between the timing of catheter ablation following the first diagnosis of HF and subsequent clinical outcomes in patients with established AF. METHODS: We performed a retrospective propensity-score-matched cohort study using the TriNetX Research Network. Adults (≥18 years) with AF who subsequently developed HF and underwent catheter ablation were included. The primary analysis compared ablation from day 1 through 3 months after HF diagnosis with ablation at least 91 days after HF diagnosis. Propensity-score matching yielded 2,570 patients in each group. Outcomes were assessed for 2 years after ablation and included all-cause mortality, electrical cardioversion, emergency department or inpatient encounters, and HF exacerbation. A 1-year timing threshold and analyses stratified by recorded left ventricular ejection fraction were examined as sensitivity analyses. RESULTS: Mean follow-up was 549.3±253.2 days after early ablation and 534.1±255.3 days after later ablation. Mortality was similar between groups (11.0% vs 10.0%; hazard ratio [HR] 1.078, 95% confidence interval [CI] 0.910-1.276; p = 0.384), as were emergency department or inpatient encounters (66.2% vs 65.6%; HR 1.006, 95% CI 0.940-1.076; p = 0.865). Early ablation was associated with fewer cardioversions (15.0% vs 18.6%; HR 0.788, 95% CI 0.689-0.901; p < 0.001) and fewer HF exacerbation events (39.5% vs 46.0%; HR 0.824, 95% CI 0.758-0.896; p < 0.001). The 1-year timing analysis showed a similar pattern for cardioversion and the HF exacerbation. CONCLUSIONS: Among patients with AF and HF who ultimately underwent ablation, ablation within 3 months of HF diagnosis was associated with fewer subsequent cardioversions and HF exacerbations than ablation performed from day 91 onward. However, there was no significant difference in mortality between the two cohorts. These findings identify the first months after HF diagnosis as a clinically relevant period for reassessing rhythm-control strategy and warrant prospective evaluation of ablation timing after HF recognition.