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TOPLINE:

A significant proportion of patients undergoing atrial fibrillation (AF) ablation as part of the CABANA trial had a high probability of heart failure with preserved ejection fraction (HFpEF). These patients experienced greater benefits from AF ablation for cardiovascular outcomes and New York Heart Association (NYHA) functional status than patients with a low probability of HFpEF.

METHODOLOGY:

• HFpEF often coexists with AF but remains underdiagnosed owing to overlapping symptoms.
• Researchers conducted a post hoc analysis of the CABANA trial to assess the prevalence of HFpEF and the effect of AF ablation in patients with a high probability of HFpEF.
• The trial included 2204 patients who were aged ≥ 65 years or < 65 years with at least one risk factor for stroke and had experienced at least two episodes of paroxysmal AF or one episode of persistent AF in the past 6 months (37.2% women; median left ventricular ejection fraction, 59%). Patients were randomly assigned to receive either AF ablation or drug therapy.
• About 1763 patients whose modified H2FPEF score could be calculated were included in this analysis, with a score ≥ 6 defined as a high probability of HFpEF.
• Endpoints included the risk for all-cause mortality and cardiovascular hospitalization, AF recurrence, and functional status (assessed using NYHA functional class and Canadian Cardiovascular Society-AF severity class) during follow-up.

TAKEAWAY:

• Patients with a high probability of HFpEF (55%) had a higher risk for AF recurrence at follow-up (odds ratio, 1.1; P = .001) and tended to have a higher risk for cardiovascular hospitalization or all-cause death.
• AF ablation resulted in a lower risk for cardiovascular hospitalization or all-cause death in patients with a high probability of HFpEF (hazard ratio, 0.82; P = .025); however, this effect was not observed in those with a low probability of HFpEF.
• Furthermore, AF ablation resulted in a lower risk for AF recurrence in both patients with a low probability and those with a high probability of HFpEF (P < .001 for both), with a greater effect observed in those with a high probability (P for interaction = .035).
• An overall improvement in the functional status was observed with AF ablation, with a slightly larger effect on NYHA functional class reduction seen in patients with a high probability of HFpEF.

IN PRACTICE:

“Identifying patients with HFpEF might allow for the initiation of disease-modifying therapies that are known to improve HFpEF status,” authors of the study wrote.

SOURCE:

This study was led by Pieter Martens, MD, PhD, of the Ziekenhuis Oost-Limburg in Genk, Belgium. It was published online on April 16, 2025, in JACC: Heart Failure.

LIMITATIONS:

The H2FPEF score was not calculable for all the patients owing to missing data. H2FPEF scores of 4 or 5 may not necessarily rule out HFpEF. The observed benefits of AF ablation may or may not be additive to those of emerging pharmacotherapies for HFpEF.

DISCLOSURES:

BioLINCC, used to access the data from the CABANA trial, was funded by the National Institutes of Health. One author was supported by a grant from the Belgian American Educational Foundation and the Frans Van de Werf Fund. Another author reported being a consultant and receiving honoraria from various medical, pharmaceutical, and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.