Introduction
Atrial fibrillation (AF) and heart failure (HF) often coexist and facilitate the occurrence and aggravate the prognosis of each other since they share common predisposing factors and pathophysiological processes1-3. However, the management of patients with AF and concomitant HF is often challenging1.
Catheter ablation has been a well-established curative therapy for AF1, 4. In patients with AF and concomitant HF, catheter ablation has been shown to improve symptoms, exercise capacity, quality of life, and LVEF5. Recently, studies showed that catheter ablation were associated with a reduction in all-cause mortality and HF hospitalization compared with medical treatment in patients with AF and HFrEF6-8.
As shown in various studies, AF is a more potent and independent prognostic factor, increasing the mortality and HF hospitalization in patients with HFpEF compared with HFrEF9, 10. However, the optimal therapy in patients with AF and HFpEF remains unclear. Specifically, the impact of catheter ablation for AF and HFpEF has not been well established. The present study was conducted to compare the long-term outcomes of catheter ablation and medical treatment in patients with AF and concomitant HFpEF. The impact of catheter ablation was also evaluated with multivariable adjustment, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW).