Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Catheter Ablation Vs. Standard Medical Therapy — a Systematic Review and Meta-Analysis Publisher Pubmed



Mahalleh M^{1, 2} ; Soleimani H¹ ; Pazoki M¹ ; Maleki S¹ ; Dastjerdi P¹ ; Ebrahimi P¹ ; Zafarmandi S¹ ; Khamene SS¹ ; Khawajah IM¹ ; Tabassum S³ ; Bhardwaj R⁴ ; Mattumpuram J⁵ ; Kaplan A⁶ ; Vaseghi M⁷ Show All Authors Show Affiliations
Source: Heart Failure Reviews Published:2025

Abstract

Background: The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF). Methods: PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization. Results: Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group. Conclusion: CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.