Heart Failure with Preserved Ejection Fraction as a Risk Factor for Atrial Fibrillation Recurrence after Ablation

Atrial fibrillation (AF) recurrence after radiofrequency ablation is closely associated with patient prognosis, while the potential impact of heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aimed to explore the effect of HFpEF on recurrence within 1 year after catheter ablation.

We enrolled 455 patients who underwent atrial fibrillation ablation, with 241 in the HFpEF group and 213 in the non-heart failure (non-HF) group. Baseline characteristics, 12-month AF recurrence rates, and predictors were compared between groups. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to assess the recurrence risk, and propensity score matching (PSM) was performed for verification.

The HFpEF group exhibited significantly higher recurrence than the non-HF group (25.0% vs. 9.8%, P < 0.001), and Kaplan-Meier analysis confirmed significant differences in 1-year recurrence-free survival (Log-rank P < 0.001). Multivariable Cox regression identified HFpEF as an independent risk factor for 1-year recurrence (HR = 1.92, 95% CI:1.06-3.47), whereas paroxysmal AF was a protective factor(HR = 0.55, 95% CI:0.31-0.98). Subgroup analysis further revealed that compared with the paroxysmal AF without heart failure (NoHF-pAF) group, HFpEF with persistent AF (HFpEF-PerAF) had significantly elevated recurrence risk (adjusted HR = 4.12, 95% CI:2.20-7.75; P < 0.001), and HFpEF with paroxysmal AF (HFpEF-pAF) also showed increased risk (HR = 2.58, 95% CI:1.14-5.84, P = 0.023). After PSM, the HFpEF group maintained significantly higher recurrence (23.0% vs. 10.0%, P = 0.016), with HFpEF remaining the sole independent predictor (HR = 2.42, 95% CI:1.17-5.00, P = 0.017).

HFpEF is an independent risk factor for 1-year recurrence after AF ablation, with highest risk in persistent AF patients. Implementing comprehensive individualized treatment strategies is essential to improve prognosis.