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.
Objectives: To evaluate long-term outcomes of catheter ablation in patients with persistent 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 persistent AF and HFpEF between September 2018 and September 2024 were identified. After 1:1 propensity score matching, 4,250 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 4.5 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 793 days, early AF ablation was associated with lower risks of the primary endpoint (HR 0.89, 95%CI:0.82-0.95, p = 0.001), lower AAD Class I or III use (HR 0.92, 95%CI:0.85-0.99, p=0.027), and numerically reduced hospitalization (HR 0.90, 95%CI:0.80-1.01, p=0.072). No significant differences were observed in HF exacerbations (HR 1.00, 95%CI:0.87-1.15, p=0.976) or mortality (HR 1.18, 95%CI:0.89-1.56, p=0.242).
Conclusion: Early catheter ablation was associated with a decreased AF recurrence and numerically reduced all-cause hospitalization in patients with HFpEF and persistent AF but did not reduce HF exacerbations or mortality.
