Comparison of Catheter Ablation in Patients with Paroxysmal Non-valvular Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction

<b>Background:</b> The efficacy of radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been established, but the efficacy and safety of cryoballoon ablation (CBA) and pulsed field ablation (PFA) remain unclear. <b>Methods:</b> This retrospective cohort study included 223 patients with paroxysmal non-valvular AF and HFpEF who underwent their first AF ablation between January 2017 and December 2021 and were divided into RFA (n = 77), CBA (n = 127), and PFA (n = 19) groups. <b>Results:</b> After a mean follow-up of 11.2 ± 1.8 months, no significant differences were observed in the rates of AF recurrence among the groups (<i>P</i> = 0.964). Both RFA and PFA were associated with a reduction in left atrial diameter and an increase in left ventricular ejection fraction (LVEF), whereas CBA showed no significant changes. The New York Heart Association (NYHA) functional classification and quality of life scores significantly improved across all groups (<i>P</i> < 0.01). No significant differences in the incidence of postprocedural complications were observed. Multivariate Cox regression analysis identified serum albumin (ALB) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) as independent predictors of AF recurrence post-ablation. <b>Conclusion:</b> RFA, CBA, and PFA are all effective in maintaining sinus rhythm in patients with paroxysmal non-valvular AF and HFpEF. RFA and PFA were associated with improved quality of life, improved NYHA functional classification, reversal of atrial remodeling, and increased LVEF. While CBA improved quality of life and NYHA functional status, it did not reverse atrial remodeling or increase LVEF. ALB and NT-pro BNP levels were identified as independent predictors of AF recurrence post-ablation in HFpEF patients.