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Effectiveness of Catheter Ablation for Patients With Atrial Fibrillation and Heart Failure

Zhou Le1, Jue Wang1, Yize Zhao1

  • 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

Pacing and Clinical Electrophysiology : PACE
|October 25, 2025
PubMed

Insights

Catheter ablation (CA) significantly reduced mortality and cardiovascular events in patients with atrial fibrillation (AF) and heart failure (HF) compared to drug therapy. This real-world study highlights CA as a potentially superior treatment option for this complex patient group.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) commonly complicates heart failure (HF), increasing patient morbidity and mortality.
  • While catheter ablation (CA) benefits selected AF patients with heart failure with reduced ejection fraction (HFrEF), its efficacy in heart failure with preserved ejection fraction (HFpEF) remains less clear.
  • Real-world data are crucial to understand CA's benefits across the spectrum of HF populations.

Purpose of the Study:

  • To investigate the impact of catheter ablation (CA) versus pharmacological treatment on clinical outcomes in patients with atrial fibrillation (AF) and heart failure (HF).

Main Methods:

  • Prospective enrollment of AF and HF patients in the China-AF Registry (August 2011-December 2020).
  • Propensity score matching (PSM) was used to create comparable cohorts for CA and pharmacological treatment.
  • Primary endpoint was all-cause mortality; secondary endpoints included thromboembolism and cardiovascular death.

Main Results:

  • After PSM, 604 patients were in the CA group and 604 in the pharmacological group.
  • The CA group exhibited significantly lower all-cause mortality (4.8% vs. 14.1%; adjusted HR 0.54) over a mean 4.16-year follow-up.
  • Catheter ablation was also linked to reduced risks of cardiovascular death (adjusted HR 0.35) and thromboembolism (adjusted HR 0.48).

Conclusions:

  • In a real-world cohort of AF and HF patients, catheter ablation demonstrated improved clinical outcomes compared to pharmacological therapy.
  • These findings suggest CA may be a beneficial treatment strategy for AF patients with HF.
  • Further confirmation from prospective randomized studies is warranted due to potential residual confounding.
Abstract

Keywords:
atrial fibrillationcatheter ablationheart failure

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