Impact of catheter ablation for persistent atrial fibrillation with heart failure, compared to preserved and reduced ejection fraction

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Catheter ablation for persistent atrial fibrillation (AF) in patients with heart failure is known to improve heart failure. However, there were few reports comparing the outcomes of catheter ablation for patients with heart failure with reduced ejection fraction (HFpEF) and heart failure with preserved ejection fraction (HFpEF). METHOD: Patients with E/e’ > 15 and EF > 50% on preoperative echocardiography were defined HFpEF, and those with EF < 40% were defined as HFrEF. We compared ablation outcomes and postoperative BNP changes between patients with HFpEF (HFpEF-group) and HFrEF (HFrEF-group). RESULT: There were 166 cases of HFpEF-group and 177 of HFrEF-group among the cases with catheter ablation for persistent AF in our hospital from 2013 to 2021. The median preoperative BNP was 190.7 pg/ml in HFrEF-group and 144.3 in HFpEF-group, significantly higher in HFrEF-group (P=0.001). After a mean follow-up of 37.2 months, maintenance of sinus rhythm without any antiarrhythmic drugs was significantly better in the HFrEF-group (64.4% and 53.6%, p=0.048). After one year of ablation, median BNP was significantly higher in HFpEF-group (HFpEF: 37.5 pg/ml, HFrEF: 22.0 pg/ml; p=0.017), contrary to before ablation. CONCLUSION: Catheter ablation for persistent AF with HFrEF showed better ablation outcomes and improved BNP levels compared to those with HFpEF.