Impact of early catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction - real world evidence

Abstract Introduction Catheter ablation for atrial fibrillation (AF) has been shown to reduce mortality and heart failure (HF) progression in patients with AF and HF with reduced ejection fraction; however, outcomes in HF with preserved ejection fraction (HFpEF), especially the optimal timing of ablation remain uncertain. Purpose To evaluate long-term outcomes of catheter ablation in patients with AF and HFpEF based on the temporal correlation between the AF diagnosis and the ablation procedure utilizing real-world data. Methods In this observational cohort study using the U.S. Collaborative Network in TriNetX, adults with AF and HFpEF between October 2018 and October 2024 were identified. After 1:1 propensity score matching, 5,550 patients were included. The primary endpoint was a composite of cardioversion, new antiarrhythmic drug (AAD) therapy, or repeat AF ablation after a 3-month blanking period. Secondary endpoints included hospitalization, mortality, HF exacerbation, and AAD use over 4 years of follow-up. Outcomes were compared between patients undergoing ablation within one year of AF diagnosis and those having ablation after one year. Results Over a mean follow-up of 742 days, early AF ablation was associated with lower risks of the primary endpoint (HR 0.81, 95%CI:0.76-0.87, p0.001), reduced hospitalization (HR 0.77, 95%CI:0.70-0.87, p0.001), and lower AAD Class I or III use (HR 0.82, 95%CI:0.77-0.88, p0.001). No significant differences were observed in HF exacerbations (HR 0.99, 95%CI:0.89-1.00, p=0.950) or mortality (HR 1.18, 95%CI:0.91-1.53, p=0.211). Conclusion Early catheter ablation was associated with a decreased all-cause hospitalization and AF recurrence in HFpEF patients but did not reduce HF exacerbations or mortality.Incidence of Primary Endpoint