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Long-Term Outcomes of Catheter Ablation in Heart Failure With Reduced Ejection Fraction Patients With Atrial

Mohammed Nor1, Olayiwola Bolaji2, Ali Bilal3

  • 1Internal Medicine Department, Stamford Hospital/Columbia University College of Physicians and Surgeons, Stamford, Connecticut, USA.

Pacing and Clinical Electrophysiology : PACE
|August 8, 2025
PubMed

Insights

Catheter ablation (CA) for atrial fibrillation (AF) in heart failure with reduced ejection fraction (HFrEF) patients significantly lowers mortality and hospitalizations but increases heart failure hospitalizations. Careful patient selection is crucial for optimal outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Catheter ablation (CA) is an effective treatment for symptomatic atrial fibrillation (AF).
  • Long-term outcomes of CA in patients with heart failure with reduced ejection fraction (HFrEF) are not well-established.
  • Understanding CA's impact on HFrEF patients with AF is critical for clinical decision-making.

Purpose of the Study:

  • To evaluate the clinical outcomes of catheter ablation (CA) compared to conventional therapy.
  • To assess the impact of CA on mortality, hospitalization, and AF recurrence in patients with HFrEF and AF.

Main Methods:

  • Retrospective analysis of the TriNetX US Collaborative Network (2014-2024).
  • Inclusion of patients aged ≥18 years with HFrEF (EF < 40%) and AF.
  • Propensity score matching to compare CA cohort with conventional therapy cohort over a 3-year follow-up.
  • Primary outcome: all-cause mortality. Secondary outcomes: all-cause hospitalization, recurrent AF, heart failure (HF) hospitalization.

Main Results:

  • After matching, 64,743 patients were in each cohort (CA vs. conventional therapy).
  • CA significantly reduced all-cause mortality (HR=0.46), all-cause hospitalization (HR=0.94), and AF recurrence (HR=0.80).
  • CA was associated with a higher risk of heart failure hospitalization (HR=1.07).

Conclusions:

  • Catheter ablation (CA) offers significant long-term benefits in reducing mortality and AF recurrence for patients with AF and HFrEF.
  • CA is associated with an increased risk of heart failure hospitalization in this population.
  • Careful patient selection and post-procedural management are essential for maximizing CA benefits in HFrEF patients with AF.
Abstract

Keywords:
all cause hospitalizationatrial fibrillationcatheter ablationheart failure with reduced ejection fractionmortalitypropensity score matching

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