Evaluating the Impact of Catheter Ablation on Cardiovascular and Cerebral Outcomes in Atrial Fibrillation with Heart Failure and Preserved Ejection Fraction

Background Evidence supporting catheter ablation (CA) for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) is limited. This study evaluated the impact of CA on clinical outcomes in patients with AF and HFpEF using a global clinical database. Methods The TriNetX research network identified patients aged ≥18 years with AF and HFpEF (February 2014–June 2024). Patients were categorized by whether they underwent CA for AF. Primary outcomes included all-cause mortality, heart failure (HF) with acute exacerbation, and ischemic stroke. Secondary outcomes included progression to mildly reduced or reduced ejection fraction (EF) during follow-up. Results Patients receiving CA showed lower incidences of all-cause mortality, HF exacerbation, and ischemic stroke. There was a trend of less patients with progression to reduced EF in patients with CA. The reduction in mortality was consistent across all subgroups, while stroke reduction was more significant in females, those with better EF, without chronic kidney disease (CKD) or diabetes mellitus (DM), with hypertension (HTN), and with paroxysmal AF. The benefits in reducing HF exacerbation were particularly notable in females, those with better EF, without CKD, and with HTN. Conclusions In patients with AF and HFpEF, CA provided cardiovascular and cerebral benefits and might reduce the risk of progression to HFrEF over five years of follow-up. Additionally, CA was associated with a reduction in all-cause mortality in patients with AF and HFpEF.