Impact of early catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction-real-world evidence.

Authors

Maximilian Moersdorf, Michel Abou-Khalil, Carlo El Khoury, Qussay Marashly, Alex El Darzi, Christian Massad, Yara Menassa, Han Feng, Mohammad Montaser Atasi, Rodolfo Montiel, Philipp Sommer, Amitabh C Pandey, Christian Sohns, Nassir Marrouche

Published in

Clinical research in cardiology : official journal of the German Cardiac Society. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

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.
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.
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, 5550 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 up to 4 years of follow-up. Outcomes were compared between patients undergoing ablation within 1 year of AF diagnosis and those having ablation after 1 year.
Over a mean follow-up of 742 ± 489 days, early AF ablation was associated with lower risks of the primary endpoint (hazard ratio (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).
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.

PMID:
42579004
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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