The use of catheter ablation of atrial fibrillation (AFA) is increasing and it has now been extended to include higher risk patients, e.g. those with heart failure (HF). Most observational studies and meta-analyses of randomized controlled trials (RCTs) have suggested that AFA in HF patients is safe in the short-to-middle term and beneficial in terms of AF recurrence, hospital readmissions and quality of life [1–7]. However, considerably more RCTs have been carried out on AFA in HF with reduced EF (HFrEF) than in HF with preserved EF (HFpEF), despite in clinical practice the proportion is reversed.
