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

Background: While catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF), its impact on long-term clinical outcomes in patients with concomitant heart failure with reduced ejection fraction (HFrEF) remains uncertain.

Objective: This study aimed to evaluate the clinical outcomes of CA versus conventional therapy in patients with HFrEF and AF.

Methods: We utilized data from the TriNetX US Collaborative Network (January 2014-December 2024) with a 3-year follow-up period. Patients aged ≥18 years with HFrEF (EF < 40%) and AF were categorized into two cohorts: those received CA versus conventional therapy. Propensity score matching was performed to minimize selection bias. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization, recurrent AF, and heart failure (HF) hospitalization.

Results: After propensity score matching, 64,743 patients remained in each cohort. The mean age was 73.4 ± 11.4 years in the CA cohort and 73.5 ± 11.5 years in the control cohort (p = 0.109). CA was associated with reduced all-cause mortality (HR = 0.46, 95% CI: 0.43-0.49, p < 0.001), all-cause hospitalization (HR = 0.94, 95% CI: 0.92-0.95, p < 0.001) and recurrent AF (HR = 0.80, 95% CI: 0.79-0.82, p < 0.001) but higher HF hospitalization (HR = 1.07, 95% CI: 1.06-1.08, p < 0.001) compared to conventional therapy.

Conclusions: Our study demonstrated that in patients with AF and HFrEF, CA was associated with significantly reduced all-cause mortality, all-cause hospitalization, and AF recurrence, but an increased risk of HF hospitalization compared to conventional therapy. These findings suggest that CA may provide substantial long-term benefits in this high-risk population, while highlighting the importance of careful patient selection and post-procedural management.