Abstract 4141915: Catheter Ablation for Atrial Fibrillation May Improve Mortality in Patients with Heart Failure with Preserved Ejection Fraction, Similar to Reduced Ejection Fraction

Introduction: Atrial remodeling in HFpEF typically results in impaired ventricular diastolic function, and the maintenance of sinus rhythm would be key to improve clinical outcomes in these patients. The CABANA trial provides limited evidence for the benefits of AF ablation in HFpEF patients. While observational studies suggest otherwise, the results of upcoming RCTs like AMPERE and CABA-HFPEF may offer deeper insights. Objective: This study examines the inpatient outcomes of hospitalized HFpEF patients with AF who underwent catheter ablation Methods: A retrospective analysis of a nationwide inpatient database from 2017 to 2019 was conducted. The study included patients diagnosed with both HFpEF and AF. A propensity score-matched cohort compared HFpEF and AF patients who underwent catheter ablation with those who did not. Results: Among 8.2 million HFpEF patients, 2.6 million had AF, and 24,015 underwent catheter ablation. Mortality was significantly lower in the ablation group compared to the control group (4.6% vs. 1.7% in unmatched cohort, 3.8% vs. 1.7% in matched cohort). The adjusted hazard ratio for mortality was 0.43 (95% CI: 0.34-0.55, p<0.00), indicating a 57% lower risk of death in the ablation group. Conclusion: Catheter ablation may offer mortality benefits for HFpEF patients with AF, as suggested by this study. This could foreshadow the findings of ongoing trials like AMPERE and CABA-HFPEF, indicating that ablation could be a valuable treatment option for this high-risk patient group not responding well to standard therapies.