Predictors of af recurrence one year after catheter ablation in a hf population

Background

Atrial fibrillation (AF) frequently coexists with heart failure and is associated with adverse clinical outcomes. Catheter ablation is an effective strategy for rhythm control in selected patients; however, recurrence of AF remains common during follow-up. Identifying factors associated with AF recurrence after ablation is clinically relevant, as it may improve patient selection, guide procedural strategies, and inform post-ablation management. In patients with heart failure, structural and functional cardiac abnormalities may further influence arrhythmia recurrence, highlighting the importance of evaluating predictors of AF recurrence in this specific population.

Aim

The aim of this study was to identify clinical and procedural factors associated with atrial fibrillation recurrence at one-year follow-up after catheter ablation in a population of patients with heart failure.

Results

A total of 380 patients with heart failure undergoing catheter ablation for atrial fibrillation between 2016 and 2024 were included in the study. Women represented 32% of the population. The mean left ventricular ejection fraction (LVEF) was 49% (95% CI: 47–51).

At one-year follow-up, AF recurrence was observed in 31% of patients. Univariate analysis identified several clinical and procedural variables potentially associated with AF recurrence. These variables were subsequently included in a multivariable logistic regression model. In multivariable analysis, hypertension (OR = 1.88, p = 0.016), diabetes mellitus (OR = 2.00, p = 0.020), dyslipidemia (OR = 1.25, p = 0.023), and persistent atrial fibrillation (OR = 3.21, p = 0.007) were independently associated with AF recurrence at one year. No consistent association was observed between the type of ablation energy and atrial fibrillation recurrence, with radiofrequency and cryoballoon ablation showing comparable outcomes (OR = 1.05, p = 0.62).

Conclusion

In a population of patients with heart failure undergoing catheter ablation for atrial fibrillation, AF recurrence at one year remained frequent. Several clinical factors were independently associated with recurrence risk, while the type of ablation energy was not. These findings highlight the multifactorial nature of AF recurrence in heart failure patients and support the need for careful clinical assessment and risk stratification when selecting candidates for catheter ablation.For image description, please refer to the figure legend and surrounding text.