Abstract
Abstract Background Heart failure (HF) and atrial fibrillation (AF) frequently coexist, with each condition worsening the other. AF ablation may provide functional benefits in HF, but long-term outcomes across HF types remain incompletely defined. Methods A total of 124 consecutive HF patients underwent AF ablation: 58 with reduced left ventricular ejection fraction (LVEF) and 64 with preserved LVEF. Pulmonary vein isolation was performed in all patients, with additional linear ablation, like "box lesion" created as needed. Patients were followed for a mean of 28.2 ± 18.8 months. Predictors of LVEF improvement and LV remodeling were analyzed. Results LVEF improved to ≥50% in 33 (72.5%) of patients with reduced LVEF, with LV end-diastolic dimension (LVEDD) reduction serving as a significant predictor (OR = 0.663; p = 0.005). In the preserved LVEF group, LVEDD shortening ≥5 mm occurred in 21 patients (29.1%), most strongly predicted by freedom from AF recurrence after the first ablation (OR = 5.559; p = 0.009). Conclusion Ablation of atrial fibrillation in patients with heart failure resulted in meaningful structural and functional cardiac improvements in both reduced and preserved LVEF groups. Patients with reduced LVEF frequently demonstrated normalization of systolic function, particularly when LVEDD decreased following ablation. In those with preserved LVEF, early freedom from recurrence was strongly associated with LV remodeling. These findings support AF ablation as an effective therapeutic strategy in heart failure patients, contributing to favorable long-term outcomes.