Abstract
Introduction: The differences in outcomes between catheter ablation (CA) versus antiarrhythmic drugs (AAD) for atrial fibrillation (AF) in the setting of heart failure with preserved ejection fraction (HFpEF) are not known. Hypothesis: We hypothesize that patients with AF and HFpEF who undergo CA will have lower morality, stroke/TIA, and acute HF compared to those treated with AAD. Methods: TriNetX, a national retrospective electronic database, was used to identify patients aged 18-80 years with AF and HFpEF from 2017-2023. Patients with a prior diagnosis of systolic HF or cross overs from AAD to CA were excluded. Patients who underwent CA were compared to those treated with AAD (amiodarone, flecainide, dronedarone, dofetilide, propafenone, sotalol). Baseline group comparison was performed using student’s t-test. Age, sex, chronic kidney disease, COPD, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and stroke/TIA were used for 1:1 propensity matching. Kaplan Meier curves were calculated to compare all-cause mortality, stroke/TIA, acute diastolic and systolic HF. Results: Patients who received CA (n=1468) and AAD (n=7426) were propensity matched yielding 1008 patients per cohort. Compared to AAD, CA demonstrated significantly lower all-cause mortality (9.13% vs. 23.7%; HR=2.6; 95% CI [2.038,3.315]; log-rank p<0.0001), lower stroke/TIA risk (5.12% vs. 7.69%; HR=1.6; 95% CI [1.056,2.28]; log-rank p=0.02), and less frequent hospitalization for acute diastolic HF (12.1% vs. 18.8%; HR=1.6; 95% CI [1.185,2.152]; log-rank p=0.0018). Rate of acute systolic HF was similar for both cohorts with 7.76% for CA and 6.90% for AAD (HR=0.88; 95% CI [0.63,1.222]; log-rank p=0.4395). Conclusions: Patients with AF and HFpEF had lower mortality, risk of stroke and acute diastolic HF when they received CA versus AAD. Randomized clinical trials are needed to better understand their short and long-term outcomes.
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