Optimal timing of AF ablation in heart failure remains an ongoing clinical question. This study, published in the Journal of Cardiovascular Electrophysiology, used data from the TriNetX network (2010 to 2024) to evaluate whether early ablation provides advantages over delayed intervention in adults with HFrEF and HFpEF.

Patients were grouped by timing of ablation: early treatment within one year of first AF diagnosis or delayed treatment between one and three years. Propensity score matching created balanced cohorts. AF recurrence was defined by repeat ablation, direct current cardioversion, or the need for antiarrhythmic drugs after a three-month blanking period.

Delayed ablation was associated with a higher recurrence risk in both groups. The hazard ratio was 1.28 in HFrEF with a p value below 0.001 and 1.21 in HFpEF with a p value of 0.02. In HFrEF, delayed timing led to more redo ablations, greater AAD use, and more DCCV procedures. In HFpEF, higher recurrence with delayed ablation was driven by increased use of antiarrhythmic drugs.

Stroke, heart failure hospitalization, and mortality rates over five years remained similar between early and delayed ablation. These findings show that earlier ablation improves rhythm control in both heart failure subtypes but does not change long-term safety outcomes.