Kardiologiia. 2026 Feb 11;66(1):73-83. doi: 10.18087/cardio.2026.1.n3019.
ABSTRACT
Objective To evaluate the impact of radiofrequency catheter ablation versus conservative medical therapy on long-term survival, cardiac function, and clinical outcomes in patients with heart failure (HF) and atrial fibrillation (AF).Material and methods The records of 328 patients with HF and AF treated at our institution from January 2015 through December 2020 were retrospectively analyzed. Included were165 patients in a radiofrequency ablation group and 163 patients in a medical therapy group. The primary endpoint was all-cause mortality, and secondary endpoints included cardiovascular death, HF hospitalization, cardiac function improvement, and AF recurrence, among others. The median follow-up time was 45 mos (range 12-60 mos). Survival analysis was performed using the Kaplan-Meier method, and independent predictive factors were evaluated with Cox proportional hazards regression models.Results The radiofrequency ablation group had higher 5 yr survival rates compared to the medical therapy group (p=0.021), with lower 5 yr cardiovascular mortality (p=0.024). The ablation group had a lower HF hospitalization rate (p=0.008). At 12 mos post-procedure, the ablation group had an increase in left ventricular ejection fraction (LVEF) of 8.3±6.4 % from baseline, while the medical therapy group increased only 0.4±4.2 % (p<0.001). In the ablation group, 72.7 % of the patients had an LVEF increase ≥5 %, compared to 28.2 % in the medical therapy group (p<0.001). The 60 mo AF-free rate was 68.5 % in the ablation group, higher than the 21.5 % in the medical therapy group (p<0.001). Multivariate analysis showed that radiofrequency ablation was an independent protective factor for all-cause mortality (p=0.031). Patients with paroxysmal AF had lower baseline LVEF than those with persistent AF (p=0.003), with AF duration, ventricular rate, concomitant coronary artery disease, and BNP concentrations as independent correlates.Conclusion Radiofrequency catheter ablation can improve long-term survival, cardiac function, and quality of life in patients with HF and AF, while reducing HF hospitalization events. Radiofrequency ablation represents an important treatment option for this patient population.
PMID:41671026 | DOI:10.18087/cardio.2026.1.n3019