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. 2025 Feb;16(1):33-43.
doi: 10.14740/cr2020. Epub 2025 Jan 21.

Atrial Fibrillation Recurrence Post-Ablation Across Heart Failure Categories: A Systematic Review and Meta-analysis

Carl Hashem  1 , Jacob Joseph  2   3   4 , Scott Kinlay  4   5   6   7 , Adelqui O Peralta  4   5   6 , Peter S Hoffmeister  4   5   6 , Matthew F Yuyun  4   5   6
Affiliations

Atrial Fibrillation Recurrence Post-Ablation Across Heart Failure Categories: A Systematic Review and Meta-analysis

Carl Hashem et al. Cardiol Res. 2025 Feb.

Abstract

Background: Previous studies have provided evidence of reduced recurrence of atrial fibrillation (AF), all-cause mortality, and heart failure (HF) hospitalizations after catheter ablation (CA) in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the efficacy of AF ablation and clinical endpoints in HF with mildly reduced ejection fraction (HFmrEF) to HFrEF and HFpEF are lacking.

Methods: We conducted a systematic review and meta-analysis aimed at determining any differences in AF recurrence rate, all-cause mortality, and HF hospitalizations among patients with HFrEF, HFmrEF, and HFpEF who underwent AF ablation. A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library databases was performed until October 31, 2023.

Results: A total of seven studies comprising 3,795 patients were retained: HFrEF 1,281 (33.8%), HFmrEF 870 (22.9%), and HFpEF 1,644 (43.3%). After median follow-up of 24 months, there was no significant difference in rate of AF recurrence between the three HF categories: HFrEF 40% (30-49%), HFmrEF 35% (28-43%); and HFpEF 35% (25-45%). Only two studies which included outcomes in the three HF categories were identified. Pooled hazard ratio (HR) of all-cause mortality and HF hospitalization combined after ablation or other rhythm control compared to other conservative management were: HFrEF 0.77 (0.63 - 0.94); HFmrEF 0.81 (0.55 - 1.20); and HFpEF 0.74 (0.55 - 1.00).

Conclusions: CA has similar efficacy in the long-term resolution of AF among patients with HFrEF, HFmrEF, and HFpEF. Further studies are needed to provide a robust analysis on the potential impact of CA on all-cause mortality.

Keywords: Ablation; Atrial fibrillation; Heart failure with mildly reduced ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Figure 1
Figure 1
CONSORT diagram of literature search and identification of relevant studies all three heart failure categories based on left ventricular ejection fraction and atrial fibrillation.
Figure 2
Figure 2
Pooled atrial fibrillation recurrence rate (95% CI) after ablation between the three heart failure categories. CI: confidence interval; AF: atrial fibrillation; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
Figure 3
Figure 3
Pooled hazard ratio (95% CI) of all-cause mortality and heart failure hospitalization after ablation or other rhythm control compared to other conservative management between the heart failure categories. CI: confidence interval; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
Figure 4
Figure 4
Funnel plot (a) and contour-enhanced funnel plot (b) of atrial fibrillation recurrence post-ablation studies included in meta-analysis. Egger’s test P value = 0.4175. CI: confidence interval; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
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