Comparison of outcomes after ablation of atrial fibrillation in patients with heart failure with preserved versus reduced ejection fraction: a US retrospective cohort analysis.

BACKGROUND

Atrial fibrillation (AF) ablation is a class I recommendation for patients with heart failure (HF) and reduced ejection fraction (HFrEF). However, data regarding the efficacy of catheter ablation in patients with heart failure and preserved ejection fraction (HFpEF) is limited. We aim to evaluate the impact of catheter ablation in patients with HFpEF compared to those with HFrEF.

METHODS

We conducted a retrospective analysis using the TriNetX database from January 2016 to July 2022. Patients aged 18 years or older with AF and HF undergoing their first catheter ablation were included. Based on all baseline characteristics, propensity score matching (PSM) (1:1) was performed. The primary outcomes were the recurrence of AF, acute heart failure, and all-cause mortality over a 3-year follow-up.

RESULTS

Our study included 4771 patients with HFpEF and 5663 patients with HFrEF. After PSM, there were 2893 patients in each group. There was no significant difference between HFpEF and HFrEF in AF recurrence (HR, 1.045; 95% CI [0.971, 1.124], Log-rank p = 0.243), acute heart failure (HR, 1.001; 95% CI [0.905, 1.108], Log-rank p = 0.982), and all-cause mortality (HR, 0.915; 95% CI [0.760, 1.101], Log-rank p = 0.346). However, HFpEF was significantly associated with an increased risk of ischemic stroke/transient ischemic attack (TIA) (HR, 1.255; 95% CI [1.061, 1.483], Log-rank p = 0.008), bleeding complications (HR, 1.287; 95% CI [1.099, 1.508], Log-rank p = 0.002), acute kidney injury (HR, 1.199; 95% CI [1.070, 1.342], Log-rank p = 0.002), pericardial complications (HR, 1.304; 95% CI [1.102, 1.542], Log-rank p = 0.002), brain natriuretic peptide (BNP) ≥ 150 pg/mL (HR, 1.185; 95% CI [1.046, 1.342], Log-rank p = 0.008), and all-cause hospitalizations (HR, 1.184; 95% CI [1.088, 1.288], Log-rank p < 0.001). In contrast, HFrEF was significantly associated with an increased risk of cardiac-related hemodynamic instability (HR, 0.725; 95% CI [0.574, 0.915], Log-rank p = 0.007).

CONCLUSION

There was no significant difference between HFpEF and HFrEF in AF recurrence, acute heart failure, and all-cause mortality after catheter ablation. However, HFpEF was significantly associated with an increased risk of ischemic stroke/TIA, bleeding complications, acute kidney injury, pericardial complications, BNP ≥ 150 pg/mL, and all-cause hospitalizations. Conversely, HFrEF was significantly associated with an increased risk of cardiac-related hemodynamic instability.