{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:27:53Z","timestamp":1787120873123,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Background<\/jats:title>\n Catheter ablation improves outcomes in atrial fibrillation (AF) with heart failure with reduced ejection fraction, but its efficacy in heart failure with preserved ejection fraction (HFpEF) remains uncertain. We performed a systematic review and reconstructed individual patient data meta-analysis to evaluate catheter ablation compared with medical therapy in this population.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Electronic databases were searched from inception through December 8, 2025, for randomized and observational studies comparing catheter ablation with medical therapy in adults with AF and HFpEF (LVEF \u226550% or guideline-consistent definitions). Primary outcomes were all-cause mortality and heart failure (HF) hospitalizations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Across 13 studies (45,642 patients), catheter ablation was associated with significantly lower all-cause mortality (HR 0.55, 95% CI 0.42\u20130.73;\n p<\/jats:italic>\n \u2009&lt;\u20090.0001), reduced HF hospitalizations (HR 0.67, 95% CI 0.52\u20130.86;\n p<\/jats:italic>\n \u2009=\u20090.001), lower stroke\/TIA risk (RR 0.89, 95% CI 0.79\u20130.99;\n p<\/jats:italic>\n \u2009=\u20090.04) and reduced AF\/atrial arrhythmia recurrence (HR 0.59, 95% CI 0.51\u20130.69;\n p<\/jats:italic>\n \u2009&lt;\u20090.00001). Reconstructed Kaplan\u2013Meier curves demonstrated consistent time-to-event separation favouring catheter ablation across these outcomes. All-cause hospitalizations were lower (HR 0.90, 95% CI 0.81\u20131.00;\n p<\/jats:italic>\n \u2009=\u20090.05), but not significant. Exploratory analyses demonstrated directionally favourable reductions in NT-proBNP and small changes in LVEF following ablation.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Catheter ablation may confer prognostic benefit in selected AF and HFpEF populations, though large, randomized trials are needed to confirm these findings.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261278738, PROSPERO, CRD420261278738<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1883350","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:47:48Z","timestamp":1787118468000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of catheter ablation in atrial fibrillation with heart failure with preserved ejection fraction: an updated systematic review and reconstructed individual patient data meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Srilakshmi","family":"Ajith","sequence":"first","affiliation":[{"name":"University Hospitals Birmingham","place":["Birmingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Knezevic-Maragh","sequence":"additional","affiliation":[{"name":"Ross University School of Medicine","place":["Bridgetown, Barbados"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bradach","sequence":"additional","affiliation":[{"name":"St.George\u2019s University School of Medicine, University Centre Grenada","place":["St. George's, Grenada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel F.","family":"Alqeeq","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute (CVRI), Mater Private Network","place":["Dublin, Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Al-Tawil","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, Trier Heart Centre","place":["Trier, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, Trier Heart Centre","place":["Trier, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.1016\/j.jacc.2016.08.048","article-title":"Heart failure with preserved ejection fraction and atrial fibrillation","volume":"68","author":"Kotecha","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e29","DOI":"10.1161\/CIR.0000000000000152","article-title":"Heart 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