Key result
HFrEF etiology does not impact 12-month atrial tachyarrhythmia recurrence after first-time PVI.
Why the study?
Catheter ablation is a key rhythm control strategy in patients with AF and HFrEF, but whether the underlying cardiomyopathy etiology influences outcomes after PVI remains uncertain.
Does first-time single-shot pulmonary vein isolation have different atrial tachyarrhythmia recurrence and safety outcomes across different HFrEF etiologies in patients with atrial fibrillation and HFrEF (LVEF ≤40%)?
Cohort (n=694)
Yes
Does first-time single-shot pulmonary vein isolation have different atrial tachyarrhythmia recurrence and safety outcomes across different HFrEF etiologies in patients with atrial fibrillation and HFrEF (LVEF ≤40%)?
In patients with atrial fibrillation and HFrEF undergoing first-time single-shot PVI, overall arrhythmia recurrence and safety at 12 months are comparable regardless of whether the underlying cardiomyopathy is ischemic, non-ischemic dilated, or AF-mediated, though organized atrial tachycardias are more common in ischemic cardiomyopathy.
HFrEF etiology should not guide PVI decisions; observational data leaves open need for prospective confirmation.
Background Catheter ablation-based rhythm control has become a key therapeutic strategy in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). However, whether the underlying cardiomyopathy etiology influences ablation outcomes remains uncertain. Purpose To evaluate the impact of HFrEF etiology on rhythm outcomes and safety following pulmonary vein isolation (PVI) in patients with AF and HFrEF (LVEF ≤40%) Methods In this retrospective, international multicenter study, patients with paroxysmal or persistent AF and HFrEF undergoing first-time single-shot PVI-only (pulsed field or cryoballoon ablation) between 2012 and 2025 were included. Patients were stratified by HFrEF etiology: ischemic cardiomyopathy (ICM), non-ischemic dilated cardiomyopathy (NI-DCM), or AF-mediated cardiomyopathy (AF-CM). The primary efficacy endpoint was the first documented recurrence of any atrial tachyarrhythmia after a 3-month blanking period. Safety endpoints comprised all-cause death, stroke/transient ischemic attack, and procedure-related adverse events. Results A total of 694 patients from 12 centers in Germany and Canada were analyzed. At 12 months, Kaplan–Meier estimates of atrial tachyarrhythmia recurrence were comparable across etiologies (ICM 32.2%, NI-DCM 32.9%, AF-CM 30.9%; log-rank P=0.91). The pattern of recurrent arrhythmias differed significantly between etiologies (P=0.04), with organized atrial tachycardias most frequent in ICM (25%), intermediate in NI-DCM (19%), and least common in AF-CM (9%). Safety outcomes were similar, with no significant differences in all-cause mortality (2.2% vs. 0.6% vs. 2.0%; P=0.39) or procedure-related adverse events (5.5% vs. 2.3% vs. 3.3%; P=0.19). Conclusions In patients with AF and HFrEF undergoing first-time PVI, efficacy and safety are comparable across cardiomyopathy etiologies, while arrhythmia recurrence patterns vary by etiology.12m KM recurrence rates by HFrEF etiology
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Boehmer et al. (2026) conducted a cohort in Atrial fibrillation and heart failure with reduced ejection fraction (LVEF ≤40%) (n=694). Ischemic cardiomyopathy (ICM) vs. Non-ischemic dilated cardiomyopathy (NI-DCM) vs. AF-mediated cardiomyopathy (AF-CM) undergoing first-time PVI vs. Comparison across HFrEF etiologies (ICM, NI-DCM, AF-CM) was evaluated on First documented recurrence of any atrial tachyarrhythmia after a 3-month blanking period at 12 months (p=0.91). HFrEF etiology did not significantly impact 12-month atrial tachyarrhythmia recurrence after first-time PVI (ICM 32.2%, NI-DCM 32.9%, AF-CM 30.9%; P=0.91).
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