Background We aimed to compare the long-term outcomes of
catheter ablation and medical treatment in patients with atrial
fibrillation (AF) and heart failure with preserved ejection fraction
(HFpEF). Methods We retrospectively screened consecutive
patients with AF and HFpEF who received catheter ablation or medical
treatment from December 2017 to June 2021 in our institution. The
primary endpoint was defined as a composite of all-cause death,
thromboembolic events and heart failure (HF) hospitalization.
Multivariate analysis, 1:1 propensity score matching (PSM) and inverse
probability of treatment weighting (IPTW) were employed to adjust for
potential confounders. Results A total of 131 patients were
included, among whom 71 patients (54.2%) underwent 1.15 + 0.36 catheter
ablation procedures. During a median follow-up of 31.8 months, the
incidence of the primary endpoint was significantly lower in catheter
ablation group (9.9% vs 25.0%, log rank p = 0.018) compared with
medical treatment group. In the multivariate model, catheter ablation
was independently associated with a lower incidence of the primary
endpoint (hazard ratio 0.281, 95% confidence interval 0.110 – 0.721, p
= 0.008), which was consistent both in PSM and IPTW cohorts. The New
York Heart Association class [2 (1, 2) vs 2 (2, 2), paired p
< 0.001], N-terminal pro-B type natriuretic peptide level
[334.3 (187.1, 821.8) vs 859.2 (308.4, 1903.0), paired p <
0.001] and left atrial diameter (39.4 + 6.4 vs 41.1 + 6.2, paired p =
0.001) were significantly improved at the end of follow-up in catheter
ablation group. Conclusion Catheter ablation was significantly
associated with a lower incidence of the composite endpoint, improved HF
symptoms and reverse atrial remodeling in AF and concomitant HFpEF.