ORCID

0009-0000-4503-1810 (Sarfraz)

Document Type

Article

Publication Date

2026

DOI

10.1186/s12872-026-06608-9

Publication Title

BMC Cardiovascular Disorders

Volume

Advance online publication

Pages

25 pp.

Abstract

Introduction: Atrial fibrillation (AF) is highly prevalent in heart failure (HF) and is linked to increased mortality and hospitalization in both preserved (HFpEF) and reduced ejection fraction (HFrEF). Catheter ablation (CA) has emerged as an effective rhythm-control strategy beyond medical therapy (MT), but phenotype-specific differences remain unclear. We compared the efficacy and safety of CA versus MT in AF with HFpEF or HFrEF.

Methods: PubMed, Embase, Scopus, and Cochrane databases were searched through December 2025. Random-effects meta-analyses were conducted in R (version 4.5.3), reporting risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results: Fifteen studies involving 27,130 patients (CA: 13,579; MT: 13,551) were included. Catheter ablation significantly reduced overall all-cause mortality (RR 0.44), with a significant benefit in HFpEF (RR 0.44), whereas the reduction in HFrEF did not reach statistical significance (RR 0.53, 95% CI 0.21–1.38). Cardiovascular mortality and cardiovascular hospitalization were also reduced overall, without significant differences between HF phenotypes. Stroke and atrial arrhythmia recurrence were not significantly reduced in the primary analyses, and favorable findings observed in sensitivity analyses were considered exploratory. Catheter ablation significantly improved LVEF in HFrEF but not in HFpEF, while effects on exercise capacity and biomarkers varied across outcomes and phenotypes. Adverse events were comparable between treatment strategies.

Conclusion: Catheter ablation was associated with favorable clinical outcomes compared with medical therapy in AF with HF; however, the magnitude and statistical certainty of benefit varied across heart failure phenotypes and outcomes.

Rights

© The Authors 2026

This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "All data generated or analyzed during this study are included in the manuscript and it's supplementary file."

Original Publication Citation

Ahmed, F., Zulfiqar, A., Elshabrawi, M. N., Ayatullah, O., Qasim, S., Sarfraz, H., Tahir, H. B., Haider, F., Fatima, M., Shah, S. A. A., Kaleem, A., Altaf, M. T., Zahid, M. B. A., Dalir, N., Zia, M., Taha, A., Qadeer, A., Patel, B., & Arshad, K. (2026). Differential impact of catheter ablation across heart failure phenotypes in atrial fibrillation: A grade assessed systematic review and meta-analysis. BMC Cardiovascular Disorders. Advance online publication. https://doi.org/10.1186/s12872-026-06608-9

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