Prognostic impact of catheter ablation in atrial fibrillation with heart failure with preserved ejection fraction: an updated systematic review and reconstructed individual patient data meta-analysis
In brief
Catheter ablation halves mortality in AF patients with preserved-ejection-fraction heart failure
In a meta-analysis of 13 studies covering 45,642 patients, catheter ablation cut all-cause death by roughly 45% and lowered heart-failure hospitalizations by about one-third compared with medical therapy. Stroke risk and arrhythmia recurrence also fell modestly. Findings are promising but stem from mixed trial and observational data, so large randomized trials are still required.
- Journal
- Frontiers in cardiovascular medicine (Q1)
- Published
- 19 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Srilakshmi Ajith, Marc Knezevic-Maragh, Daniel Bradach, Basel F Alqeeq, Mohammed Al-Tawil, Assad Haneya
- PMID
- 42688291
- DOI
- 10.3389/fcvm.2026.1883350
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 6 September 2026): Meta-analysis catheter ablation improves AF with HFpEF
Abstract
BACKGROUND: Catheter ablation improves outcomes in atrial fibrillation (AF) with heart failure with reduced ejection fraction, but its efficacy in heart failure with preserved ejection fraction (HFpEF) remains uncertain. We performed a systematic review and reconstructed individual patient data meta-analysis to evaluate catheter ablation compared with medical therapy in this population. METHODS: Electronic databases were searched from inception through December 8, 2025, for randomized and observational studies comparing catheter ablation with medical therapy in adults with AF and HFpEF (LVEF ≥50% or guideline-consistent definitions). Primary outcomes were all-cause mortality and heart failure (HF) hospitalizations. RESULTS: Across 13 studies (45,642 patients), catheter ablation was associated with significantly lower all-cause mortality (HR 0.55, 95% CI 0.42-0.73; p < 0.0001), reduced HF hospitalizations (HR 0.67, 95% CI 0.52-0.86; p = 0.001), lower stroke/TIA risk (RR 0.89, 95% CI 0.79-0.99; p = 0.04) and reduced AF/atrial arrhythmia recurrence (HR 0.59, 95% CI 0.51-0.69; p < 0.00001). Reconstructed Kaplan-Meier curves demonstrated consistent time-to-event separation favouring catheter ablation across these outcomes. All-cause hospitalizations were lower (HR 0.90, 95% CI 0.81-1.00; p = 0.05), but not significant. Exploratory analyses demonstrated directionally favourable reductions in NT-proBNP and small changes in LVEF following ablation. CONCLUSION: Catheter ablation may confer prognostic benefit in selected AF and HFpEF populations, though large, randomized trials are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278738, PROSPERO, CRD420261278738.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.