Abstract Body (Do not enter title and authors here): Background:
Early catheter ablation for atrial fibrillation (AF) improves outcomes, but the optimal timing,
especially in heart failure (HF) subtypes, remains unclear.
Objective:
To evaluate the impact of ablation timing on outcomes in patients with HF with reduced ejection
fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Methods:
We used the TriNetX database (2010–2024) to identify HF patients with AF who underwent
ablation. Patients were classified as early ablation (≤1 year of first AF diagnosis) or delayed
ablation (1–3 years), with propensity score matching (PSM) applied to balance the baseline
characteristics. The primary outcome was AF recurrence, defined by repeat ablation, direct
current cardioversion (DCCV), or antiarrhythmic drug (AAD) use after a 3-month blanking
period. Secondary outcomes included stroke, hospitalization, and mortality over 5 years.
Results:
After PSM, delayed ablation was associated with higher AF recurrence in both HFrEF (HR 1.25,
p < 0.001) and HFpEF (HR 1.27, p = 0.01), as seen in multivariate analysis. In HFrEF, delayed
ablation was associated with higher incidence of re-do ablation, AAD use, and DCCV, while in
HFpEF, higher recurrence with delayed ablation was associated with increased AAD use. Both
cohorts had similar stroke and mortality rates between early and delayed ablation.
CONCLUSIONS:
Delayed ablation in HFrEF and HFpEF was linked to higher AF recurrence, driven by increased
redo ablations, DCCV, AAD use in HFrEF, and higher AAD use in HFpEF. Stroke and mortality
rates were similar, suggesting earlier ablation may enhance rhythm control without affecting
long-term survival.