Catheter Ablation Versus Antiarrhythmic Therapy for Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction

Background: Clinical outcomes among patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) treated with catheter ablation (CA) versus antiarrhythmic therapy (AAT) are not well-known.

Objectives: This study compared morbidity and mortality among patients with AF and HFpEF treated with CA versus AAT.

Methods: AF and HFpEF patients from January 2017-June 2023 were identified in TriNetX, a large global population-based database. Patients with prior diagnosis of HFrEF or crossover between AAT and CA were excluded. Baseline characteristics including age, sex, BMI, type of AF, comorbidities, and cardiovascular medications were compared. The two groups were 1:1 propensity matched for outcomes analysis. All-cause mortality, cerebrovascular accident (CVA)/transient ischemic attack (TIA), and acute HF were compared with Kaplan-Meier curves.

Results: Patients treated with CA (n=1959) and AAT (n=7689) were 1:1 propensity matched yielding 3632 patients with no significant differences in baseline characteristics. Compared to AAT, CA was associated with decreased mortality (9.2% vs. 20.5%; hazard ratio [HR]: 0.431; 95% confidence interval [CI]: 0.359 to 0.518; p<0.001). Additionally, CA was associated with reduced HFpEF (HR: 0.638; 95% CI, 0.550 to 0.741; p<0.001) and acute HFrEF (HR: 0.645; 95% CI, 0.452 to 0.920; p=0.015). There was no difference in composite of CVA/TIA (HR: 0.935; 95% CI: 0.725 to 1.207; p=0.607).

Conclusion: In this retrospective study of patients with AF and HFpEF, CA was associated with lower mortality and risk of acute heart failure when compared with AAT.