Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul 30:16:1621118.
doi: 10.3389/fphys.2025.1621118. eCollection 2025.

Targeting atrial fibrillation in HFpEF: the emerging role of pulsed field ablation

A S Parwani  1   2   3 , B Kossmann  1   2 , V Schweiger  1   2   3
Affiliations
Review

Targeting atrial fibrillation in HFpEF: the emerging role of pulsed field ablation

A S Parwani et al. Front Physiol. .

Abstract

With a rising prevalence of heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF), their frequent coexistence poses a growing clinical challenge for clinicians worldwide. HFpEF and AF share common risk factors and pathophysiological mechanisms, contributing to worsening cardiac function and remodeling. Traditional pharmacological rhythm control strategies often proved ineffective in heart failure patients, prompting increased interest in catheter ablation. Pulse Field Ablation (PFA), a novel non-thermal ablation technique utilizes irreversible electroporation and offers promising safety and efficacy advantages over conventional thermal methods by selectively targeting myocardial cells while minimizing collateral tissue damage. Early clinical data suggest that PFA may result in less atrial fibrosis and preserves atrial compliance, which could be particularly beneficial in HFpEF where diastolic function is central. Although ablation outcomes in HFpEF have been less extensively studied than in heart failure with reduced ejection fraction (HFrEF), preliminary studies report low complication rates, improved hemodynamics, and ameliorated outcomes following ablation. Registry data and subanalyses of trials like EAST-AFNET4 support early rhythm control, while the ongoing CABA-HFpEF-DZHK27 trial aims to determine whether catheter ablation improves cardiovascular outcomes in this specific population. As PFA gains traction for its procedural efficiency and favorable safety profile, its role in managing AF in HFpEF may expand. However, further robust, randomized studies are necessary to define its long-term benefits and may establish PFA as a standard therapy in this complex patient cohort.

Keywords: HFpEF; ablation for atrial fibrillation; atrial fibrillation; diastolic dysfunction; heart failure with preserved ejection fraction; pulsed field ablation (PFA).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Illustration of the ongoing CABA-HFPEF-DZHK27 Trial.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Andrade J. G., Deyell M. W., Macle L., Wells G. A., Bennett M., Essebag V., et al. (2023). Progression of atrial fibrillation after cryoablation or drug therapy. N. Engl. J. Med. 388 (2), 105–116. 10.1056/NEJMOA2212540 - DOI - PubMed
    1. Andrade J. G., Wells G. A., Deyell M. W., Bennett M., Essebag V., Champagne J., et al. (2021). Cryoablation or drug therapy for initial treatment of atrial fibrillation. N. Engl. J. Med. 384 (4), 305–315. 10.1056/NEJMOA2029980 - DOI - PubMed
    1. Benali K., Khairy P., Hammache N., Petzl A., Da Costa A., Verma A., et al. (2023). Procedure-related complications of catheter ablation for atrial fibrillation. J. Am. Coll. Cardiol. 81 (21), 2089–2099. 10.1016/J.JACC.2023.03.418 - DOI - PubMed
    1. Carroll J. D., Hess O. M., Hirzel H., Krayenbuehl H. P. (1983). Dynamics of left ventricular filling at rest and during exercise. Pathophysiol. Nat. Hist. Coron. Artery Dis. 68, 59–67. 10.1161/01.cir.68.1.59 - DOI - PubMed
    1. Chen W., Bian W., Zhou Y., Zhang J. (2021). Cardiac fibroblasts and myocardial regeneration. Front. Bioeng. Biotechnol. 9, 599928. 10.3389/FBIOE.2021.599928 - DOI - PMC - PubMed

LinkOut - more resources