Outcomes Among Drug Refractory Patients With Atrial Fibrillation (AF) and Concomitant Heart Failure With Preserved Ejection Fraction (HFpEF) Treated With Catheter Ablation Versus Antiarrhythmic Drugs

ABSTRACT Introduction Heart failure with preserved ejection fraction (HFpEF) accounts for about half of the cases of heart failure. HFpEF and atrial fibrillation (AF) often coexist and share similar risk factors. The objective of this study is to examine the differences in risk of clinical outcomes among drug refractory AF patients with concomitant HFpEF treated with catheter ablation (CA) versus antiarrhythmic drugs (AADs). Methods Using the Optum PanTher Electronic Health Record (EHR) database, adult HF patients with left ventricular ejection fraction (LVEF) ≥ 50% and an AF diagnosis with a history of AAD prescription between January 2014 and March 2021 were identified. Patients were classified into CA or AAD groups based on their subsequent treatment for AF. The primary outcome of interest included a composite of AF/atrial flutter (AFL)/atrial tachycardia‐related inpatient admissions and electrical cardioversions in the 57–730 days post‐index treatment period (follow‐up extended to 1095 days for sub‐analysis). Overall HF‐related admissions and systolic HF‐related admissions were assessed as secondary outcomes. Inverse probability of treatment weighting (IPTW) of propensity scores was used to balance the two cohorts on study covariates. Cox regression analyses were performed to examine outcomes in the covariate‐balanced cohorts. Results The final sample included 586 CA and 1436 AAD patients. The cohorts were well balanced on patient demographics and clinical characteristics after applying IPTW. Patients treated with CA had a significantly lower rate of primary composite outcome as compared to those treated with AADs (15.4% vs. 24.9%, log‐rank p test = 0.001). Cox model revealed a 34% lower risk of atrial arrhythmia related admissions and cardioversion among patients treated with CA versus AADs in the 57–730 days post‐index treatment period (Hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.50–0.87, p = 0.003). There were no significant differences in HF and systolic HF‐related admissions between the two groups (except in the subgroup analysis of patients < 70 years of age, patients with paroxysmal AF, and patients with persistent AF). Similar results were observed in sub‐analyses with 57–1095 days of follow‐up. Conclusion Among drug refractory AF patients with concomitant HFpEF, CA was shown to reduce the risk of recurrent arrhythmias as compared to AAD continuation.