Effects of Atrial Fibrillation Ablation for Heart Failure with Preserved Ejection Fraction: Insights from CABANA (JACC Heart Failure May 2025)-Article: Effects of Atrial Fibrillation Ablation for Heart Failure with Preserved Ejection Fraction: Insights from CABANA

Article: Effects of Atrial Fibrillation Ablation for Heart Failure with Preserved Ejection Fraction: Insights from CABANA

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The study, published in the Journal of the American College of Cardiology, explores the effects of atrial fibrillation (AF) ablation in patients with heart failure with preserved ejection fraction (HFpEF). Conducted as part of the CABANA trial, the investigation compared catheter ablation to drug therapy in patients with cardiovascular risk factors. The trial involved 1,763 patients, focusing on those with a high likelihood of HFpEF, determined by a modified H2FPEF score.<br /><br />Key findings indicate that AF ablation significantly reduces cardiovascular hospitalization or death in patients with a high HFpEF probability, with a hazard ratio of 0.82. Conversely, no such benefit was observed for patients without HFpEF. Despite a higher risk of AF recurrence in HFpEF patients, those undergoing ablation showed improved outcomes compared to those receiving only drug therapy.<br /><br />Further analysis revealed AF ablation led to better functional status, including lower NYHA and Canadian Cardiovascular Society (CCS) class scores post-treatment, indicating improved heart function. More weight loss after ablation also suggested better heart failure management outcomes.<br /><br />The results indicate AF ablation may provide substantial clinical benefits to HFpEF patients, enhancing survival rates and reducing hospitalizations, although no significant effect on overall mortality was observed. The study underscores the potential for targeted AF ablation therapy in managing HFpEF, suggesting the need for prioritizing early AF ablation considerations for those with elevated H2FPEF scores. However, these findings are exploratory and highlight the need for further research to confirm these benefits and explore the broader implications of AF ablation in HFpEF management.

Keywords

atrial fibrillation

HFpEF

CABANA trial

catheter ablation

drug therapy

cardiovascular risk

H2FPEF score

NYHA class

CCS class

heart failure management