MINI REVIEW article

Front. Physiol.

Sec. Cardiac Electrophysiology

Volume 16 - 2025 | doi: 10.3389/fphys.2025.1621118

This article is part of the Research TopicAtrial Fibrillation (AF) in Heart Failure with Preserved Ejection Fraction (HFpEF)View all 4 articles

Targeting Atrial Fibrillation in HFpEF: The Emerging Role of Pulsed Field Ablation

Provisionally accepted
  • Medical clinic with a focus on Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany

The final, formatted version of the article will be published soon.

With a rising prevalence of heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF), their frequent coexistence poses a growing clinical challenge for clinicians worldwide. HFpEF and AF share common risk factors and pathophysiological mechanisms, contributing to worsening cardiac function and remodeling. Traditional pharmacological rhythm control strategies often proved ineffective in heart failure patients, prompting increased interest in catheter ablation. Pulse Field Ablation (PFA), a novel non-thermal ablation technique utilizes irreversible electroporation and offers promising safety and efficacy advantages over conventional thermal methods by selectively targeting myocardial cells while minimizing collateral tissue damage. Early clinical data suggest that PFA may result in less atrial fibrosis and preserves atrial compliance, which could be particularly beneficial in HFpEF where diastolic dysfunction is central. Although ablation outcomes in HFpEF have been less extensively studied than in heart failure with reduced ejection fraction (HFrEF), preliminary studies report low complication rates, improved hemodynamics, and ameliorated outcomes following ablation. Registry data and subanalyses of trials like EAST-AFNET4 support early rhythm control, while the ongoing CABA-HFpEF-DZHK27 trial aims to determine whether catheter ablation improves cardiovascular outcomes in this specific population. As PFA gains traction for its procedural efficiency and favorable safety profile, its role in managing AF in HFpEF may expand. However, further robust, randomized studies are necessary to define its long-term benefits and may establish PFA as a standard therapy in this complex patient cohort.

Keywords: HFpEF - heart failure with preserved ejection fraction, Atrial Fibrillation, ablation for atrial fibrillation, Pulsed field ablation (PFA), Diastolic dysfunction

Received: 30 Apr 2025; Accepted: 08 Jul 2025.

Copyright: © 2025 Shokor Parwani, Kossmann and Schweiger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Abdul Shokor Parwani, Medical clinic with a focus on Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany

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