Atrial fibrillation recurrence after catheter ablation in heart failure with preserved versus reduced ejection fraction
M Caetano Coelho, F Ferreira, P Silva Cunha, G Portugal, B Valente, A Lousinha, H Santos, M Martins OliveiraAbstract
Background
Atrial fibrillation (AF) and heart failure (HF) frequently coexist. Although catheter ablation is increasingly used in HF, AF recurrence may limit sustained benefit. HF phenotypes defined by left ventricular ejection fraction (HFpEF vs HFrEF) differ in remodeling and hemodynamics, potentially influencing ablation outcomes.
Aim
To compare AF recurrence after catheter ablation between patients with HFpEF and HFrEF.
Methods
We conducted a retrospective observational study including patients with atrial fibrillation and a diagnosis of heart failure who underwent catheter ablation between 2018-2020. Heart failure phenotype was classified according to left ventricular ejection fraction as HFpEF (≥50%) or HFrEF (<40%). The primary outcome was AF recurrence, defined as documented AF/atrial tachyarrhythmia >30 s after a 3-month blanking period. Baseline clinical characteristics, echocardiographic parameters, and procedural details were collected. AF recurrence rates were compared between HF phenotypes, and multivariable logistic regression was performed to identify independent predictors of recurrence.
Results
Among HF patients (N=48), 21 had HFpEF and 13 had HFrEF (HFmrEF excluded from primary analysis). AF recurrence occurred in 47.6% of HFpEF vs 38.5% of HFrEF patients (p=0.728). Unadjusted OR for recurrence (HFrEF vs HFpEF) was 0.69 (95% CI 0.17–2.81). After adjustment for age and persistent AF, HF phenotype was not associated with recurrence (adjusted OR 1.18, 95% CI 0.23–6.11; p=0.846).
Conclusion
In patients with atrial fibrillation undergoing catheter ablation, AF recurrence rates did not differ between heart failure phenotypes defined by ejection fraction. These findings highlight the importance of HF phenotype–specific risk stratification and may inform patient selection and post-ablation management strategies in this high-risk population.For image description, please refer to the figure legend and surrounding text.