Impact of early catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction - real world evidence
M Moersdorf, M M Atasi, M Abou-Khalil, C Massad, Y Menassa, Q Marashly, H Feng, A El Darzi, C El Khoury, P Sommer, A C Pandey, C Sohns, N MarroucheAbstract
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, p<0.001), reduced hospitalization (HR 0.77, 95%CI:0.70-0.87, p<0.001), and lower AAD Class I or III use (HR 0.82, 95%CI:0.77-0.88, p<0.001). 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