The long-term outcomes of catheter ablation for atrial fibrillation in heart failure with preserved ejection fraction

Background: We aimed to compare the long-term outcomes of catheter ablation and medical treatment in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Methods: We retrospectively screened consecutive patients with AF and HFpEF who received catheter ablation or medical treatment from December 2017 to June 2021 in our institution. The primary endpoint was defined as a composite of all-cause death, thromboembolic events and heart failure (HF) hospitalization. Multivariate analysis, 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to adjust for potential confounders. Results: A total of 131 patients were included, among whom 71 patients (54.2%) underwent 1.15 + 0.36 catheter ablation procedures. During a median follow-up of 31.8 months, the incidence of the primary endpoint was significantly lower in catheter ablation group (9.9% vs 25.0%, log rank p = 0.018) compared with medical treatment group. In the multivariate model, catheter ablation was independently associated with a lower incidence of the primary endpoint (hazard ratio 0.281, 95% confidence interval 0.110 – 0.721, p = 0.008), which was consistent both in PSM and IPTW cohorts. The New York Heart Association class [2 (1, 2) vs 2 (2, 2), paired p < 0.001], N-terminal pro-B type natriuretic peptide level [334.3 (187.1, 821.8) vs 859.2 (308.4, 1903.0), paired p < 0.001] and left atrial diameter (39.4 + 6.4 vs 41.1 + 6.2, paired p = 0.001) were significantly improved at the end of follow-up in catheter ablation group. Conclusion: Catheter ablation was significantly associated with a lower incidence of the composite endpoint, improved HF symptoms and reverse atrial remodeling in AF and concomitant HFpEF.