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Peer-reviewedCC BY 4.0Journal of Interventional Cardiac Electrophysiology

Catheter ablation of atrial fibrillation in patients with heart failure - preserved and reduced ejection fraction - real world evidence

  • Maximilian Moersdorf1,2
  • Qussay Marashly1
  • Christian Massad1
  • Yara Menassa1
  • Han Feng1
  • Michel Abou-Khalil1
  • Mohammad Montaser Atasi1
  • Alex El Darzi1
  • Carlo El Khoury1
  • Philipp Sommer2
  • Amitabh C Pandey1
  • Christian Sohns2
1 more authors
  • Nassir Marrouche1,3
  1. 1Tulane Research Innovation for Arrhythmia Discovery, New Orleans, LA USA
  2. 2Department of Electrophysiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
  3. 3Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 40130 USA
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Abstract

Background: Catheter ablation for atrial fibrillation (AF) has been shown to reduce mortality and morbidity in patients with AF and heart failure with reduced ejection fraction (HFrEF) compared with medical therapy (GDMT) alone. Outcomes in patients with preserved ejection fraction remain less clearly defined. This study compared long-term outcomes of catheter ablation in patients with AF and heart failure (HF) across the spectrum of ejection fraction using real-world data.

Methods: This retrospective cohort study utilized the U.S. Collaborative Network in TriNetX to identify adults with AF and HF between September 2018 and September 2024. After 1:1 propensity score matching, 12,492 patients with HFpEF and AF and 38,150 patients with HFrEF were included. The primary endpoint was a composite including all-cause mortality, left-ventricular-assist device implantation, or heart transplantation. Secondary endpoints included hospitalization, stroke, and antiarrhythmic drug (AAD) use. Outcomes were compared between patients receiving ablation and GDMT versus GDMT alone.

Results: Over a mean follow-up of 973 days (HFpEF) and 926 days (HFrEF), AF ablation was associated with lower risks of the primary endpoint and mortality (HFpEF: hazard ratio (HR) 0.29; HFrEF: HR 0.40; all p < 0.001), as well as reduced hospitalization (HFpEF: HR 0.81; HFrEF: HR 0.75; all p < 0.001) and stroke (HFpEF: HR 0.86, p = 0.025; HFrEF: HR 0.76, p < 0.001). Patients that received ablation had more frequent AAD use despite greater cardioversion rates (HFpEF: HR 1.37; HFrEF: HR 1.08, all p < 0.001).

Conclusion: Catheter ablation conferred comparable reductions in mortality, advanced HF therapies, stroke, and hospitalization in both HFpEF and HFrEF patients.

Graphical abstract:

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10840-026-02349-z.

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Cite

BibTeXRIS
BibTeX
@article{moersdorf2026catheter,
  title = {{Catheter ablation of atrial fibrillation in patients with heart failure - preserved and reduced ejection fraction - real world evidence}},
  author = {Maximilian Moersdorf and Qussay Marashly and Christian Massad and Yara Menassa and Han Feng and Michel Abou-Khalil and Mohammad Montaser Atasi and Alex El Darzi and Carlo El Khoury and Philipp Sommer and Amitabh C Pandey and Christian Sohns and Nassir Marrouche},
  journal = {Journal of Interventional Cardiac Electrophysiology},
  year = {2026},
  month = may,
  doi = {10.1007/s10840-026-02349-z},
  url = {https://doi.org/10.1007/s10840-026-02349-z},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Catheter ablation of atrial fibrillation in patients with heart failure - preserved and reduced ejection fraction - real world evidence
AU  - Maximilian Moersdorf
AU  - Qussay Marashly
AU  - Christian Massad
AU  - Yara Menassa
AU  - Han Feng
AU  - Michel Abou-Khalil
AU  - Mohammad Montaser Atasi
AU  - Alex El Darzi
AU  - Carlo El Khoury
AU  - Philipp Sommer
AU  - Amitabh C Pandey
AU  - Christian Sohns
AU  - Nassir Marrouche
PY  - 2026
DA  - 2026/05/26
JO  - Journal of Interventional Cardiac Electrophysiology
DO  - 10.1007/s10840-026-02349-z
UR  - https://doi.org/10.1007/s10840-026-02349-z
AB  - Background: Catheter ablation for atrial fibrillation (AF) has been shown to reduce mortality and morbidity in patients with AF and heart failure with reduced ejection fraction (HFrEF) compared with medical therapy (GDMT) alone. Outcomes in patients with preserved ejection fraction remain less clearly defined. This study compared long-term outcomes of catheter ablation in patients with AF and heart failure (HF) across the spectrum of ejection fraction using real-world data.  Methods: This retrospective cohort study utilized the U.S. Collaborative Network in TriNetX to identify adults with AF and HF between September 2018 and September 2024. After 1:1 propensity score matching, 12,492 patients with HFpEF and AF and 38,150 patients with HFrEF were included. The primary endpoint was a composite including all-cause mortality, left-ventricular-assist device implantation, or heart transplantation. Secondary endpoints included hospitalization, stroke, and antiarrhythmic drug (AAD) use. Outcomes were compared between patients receiving ablation and GDMT versus GDMT alone.  Results: Over a mean follow-up of 973 days (HFpEF) and 926 days (HFrEF), AF ablation was associated with lower risks of the primary endpoint and mortality (HFpEF: hazard ratio (HR) 0.29; HFrEF: HR 0.40; all p < 0.001), as well as reduced hospitalization (HFpEF: HR 0.81; HFrEF: HR 0.75; all p < 0.001) and stroke (HFpEF: HR 0.86, p = 0.025; HFrEF: HR 0.76, p < 0.001). Patients that received ablation had more frequent AAD use despite greater cardioversion rates (HFpEF: HR 1.37; HFrEF: HR 1.08, all p < 0.001).  Conclusion: Catheter ablation conferred comparable reductions in mortality, advanced HF therapies, stroke, and hospitalization in both HFpEF and HFrEF patients.  Graphical abstract:  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10840-026-02349-z.
SN  - 1383-875X
SN  - 1572-8595
ER  -