Trial reportJournal of the American Heart Association2026
Burden of Potentially Undiagnosed Heart Failure With Preserved Ejection Fraction in Atrial Fibrillation and Effects of Catheter Ablation: Insights From CABANA.
Trial report in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
backgroundPatients with atrial fibrillation (AF) often complain of dyspnea, raising the question that symptoms could be related to unrecognized heart failure (HF) with preserved ejection fraction (HFpEF).
methodsWe used the HFpEF-age, body mass index and history of AF algorithm to estimate the probability of undiagnosed HFpEF in CABANA (Catheter Ablation vs. Antiarrhythmic Drug Therapy), and its interaction with catheter ablation on quality of life (QOL). Probable HFpEF was defined as patient-reported dyspnea with HFpEF-age, body mass index and history of AF probability≥75%. Absence of dyspnea or HFpEF-age, body mass index and history of AF probability<75% was considered to reflect patients without HFpEF. The effect of randomization to catheter ablation on QOL (Mayo Atrial Fibrillation-Specific Symptom Inventory questionnaire and EuroQol-5 Dimension-3 Level score) was assessed using mixed models.
resultsOf participants without known HF, 70% (n=1225) had probable HFpEF and the remaining 30% (n=522) did not. Those with probable HFpEF had worse New York Heart Association class, EuroQol-5 Dimension-3 Level score, Mayo Atrial Fibrillation-Specific Symptom Inventory severity, and Mayo Atrial Fibrillation-Specific Symptom Inventory frequency scores (
conclusionsNearly three quarters of CABANA participants had potentially undiagnosed HFpEF, with worse QOL and risk of HF hospitalization. Catheter ablation in probable HFpEF resulted in greater improvement in QOL, but residual QOL impairment and HF risk remained elevated despite ablation. These data reinforce the importance of diligent consideration of HFpEF among patients with symptomatic AF to ensure optimal use of foundational treatments for HF.
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