Predictors of Atrial Fibrillation Recurrence After Catheter Ablation in Heart Failure Patients: A Systematic Review of Literature

Atrial fibrillation (AF) and heart failure (HF) often coexist, worsening outcomes through a bidirectional interaction. Catheter ablation has become a cornerstone therapy, improving function, symptoms, and survival. However, recurrence of AF postablation remains a challenge, particularly in HF patients. This review synthesizes findings from 14 clinical studies (2015-2025) examining predictors of recurrence after ablation in HF with preserved ejection fraction and HF with reduced ejection fraction. Key predictors include persistent or long-standing AF, enlarged left atrial diameter, elevated inflammatory biomarkers (high-sensitivity C-reactive protein, N-terminal proBNP), red blood cell distribution width, and early arrhythmia recurrence. Comorbidities such as diabetes, thyroid dysfunction, and malnutrition (controlling nutritional status score) also contributed to recurrence risk. Procedural factors such as pulmonary vein reconnection and timing of ablation influenced outcomes. Protective factors included SGLT2 inhibitors and high-dose statins. These findings emphasize the multifactorial nature of AF recurrence in HF patients and highlight the need for individualized risk stratification. Integration of clinical, imaging, biomarker, and procedural factors may optimize patient selection and improve long-term rhythm control.