Catheter ablation as a potential treatment alternative for atrial fibrillation among patients with heart failure with preserved ejection fraction: a retrospective cohort study

Abstract Background In patients with heart failure with reduced ejection fraction, catheter ablation for atrial fibrillation is a useful alternative to drug-induced rhythm control. However, the efficacy of this procedure in patients with heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Therefore, this study aimed to assess the outcomes of the radiofrequency catheter ablation procedure for atrial fibrillation in patients with HFpEF. Methods The retrospective cohort study included 144 patients with a left ventricular ejection fraction ≥ 50% who underwent catheter ablation for atrial fibrillation for the first time. We compared clinical outcomes, including freedom from atrial arrhythmia recurrence at 12 months, symptom severity decrease measured using the European Heart Rhythm Association (EHRA) score, and all-cause hospitalizations between patients with HFpEF and those without HF. Results Among the 144 patients, 43 (29.9%) had HFpEF and 101 (70.1%) did not have HF. At the 12-month follow-up, significant difference was found in the recurrence rate of atrial arrhythmia between the two groups (41.9%, HFpEF group vs. 13.9%, non-HF group; P < 0.001). Nonetheless, no significant difference was noted in the decrease in symptom severity, evaluated using the reduction in EHRA scores, between the two groups (-1.30 ± 0.60 vs. -1.42 ± 0.55; P = 0.273). Similarly, no significant difference was observed in all-cause hospitalizations between the two groups (9.3% vs. 4.0%; P = 0.239). After adjusting for HFpEF, atrial fibrillation type, age group (age ≥ 75 vs. <75 years), atrial fibrillation duration, chronic obstructive pulmonary disease, and left atrial diameter, a significant association was noted between HFpEF and increased probability of atrial fibrillation recurrence (hazard ratio: 2.56; 95% confidence interval: 1.17–5.61; P = 0.018). Conclusions Despite the significantly lower incidence of arrhythmia-free survival within 12 months of follow-up in patients with HFpEF than in those without HF, catheter ablation for atrial fibrillation significantly reduced symptom severity. The study findings suggest catheter ablation as a potential treatment alternative for atrial fibrillation in patients with HFpEF.