Efficacy of Catheter Ablation of Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction

Background Atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) has been associated with poor clinical outcomes. Catheter ablation has been shown to be an effective way to limit recurrence of AF and reduce stroke and mortality in patients with normal ventricular function and heart failure with reduced ejection fraction (HFrEF). Efficacy of catheter ablation in patients with HFpEF is less clear. We sought to evaluate clinical outcomes in the HFpEF population with ablation plus medical therapy as compared to medical therapy alone. Methods We conducted a single-center retrospective cohort review of 180 patients from 2007 to 2017. Inclusion criteria were patients who had a hospitalization with HFpEF and AF as hospital problems, EF≥50% and age ≥40. The ablation group includes all AF patients who underwent ablation and met inclusion criteria. The medical therapy cohort also met all the inclusion criteria and excluded patients with any ablations. Medical therapy included rate control, rhythm control or both. The primary outcome was AF at 1 year. Secondary outcomes were hospital admissions, stroke, and all-cause mortality. Results Out of 180 patients who met the inclusion criteria, 85 underwent catheter ablation and 95 were managed medically. More men underwent ablation vs. medical therapy (62.5% vs. 25.3%, p Conclusion In patients with HFpEF and AF, catheter ablation along with medical therapy is an effective method of rhythm control and resulted in fewer strokes than medical management alone.