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Background:  It is unclear whether atrial fibrillation (AF) catheter ablation (AFCA) improves the left ventricular (LV) diastolic function. We evaluated the 1-year change in the H 2 FPEF score, which reflects the degree of LV diastolic function, after AFCA among patients with a normal LV systolic function.   Methods and Results:  We included 1,471 patients (30.7% female, median age 60 years, paroxysmal-type AF 68.6%) who had available H 2 FPEF scores at baseline and at 1-year after AFCA to evaluate the 1-year change in the H 2 FPEF score (ΔH 2 FPEF score [1−yr] ) after AFCA. Baseline high H 2 FPEF scores (≥6) were independently associated with the female sex, left atrium (LA) diameter, LV mass index, pericardial fat volume, and a low estimated glomerular filtration rate. One year after AFCA, decreased ΔH 2 FPEF scores [1−yr]  were associated with baseline H 2 FPEF scores of ≥6 [OR, 4.19 (95% CI, 2.88–6.11),  p  < 0.001], no diabetes [OR, 0.60 (95% CI, 0.37–0.98),  p  = 0.04], and lower pericardial fat volume [OR, 0.99 (95% CI, 0.99–1.00),  p  = 0.003]. Increased ΔH 2 FPEF scores [1−yr]  were associated with a baseline H 2 FPEF score of <6 [OR, 3.54 (95% CI, 2.08–6.04),  p  < 0.001] and sustained AF after a recurrence within 1 year [SustainAF [1−yr] ; OR, 1.89 (95% CI, 1.01–3.54),  p  = 0.048]. Throughout a 56-month median follow-up, an increased ΔH 2 FPEF score [1−yr]  resulted in a poorer rhythm outcome of AFCA (at 1 year, log-rank  p  = 0.003; long-term, log-rank  p  = 0.010).   Conclusions:  AFCA appears to improve LV diastolic dysfunction. However, SustainAF [1−yr]  may contribute to worsening LV diastolic dysfunction, and it was shown by increased ΔH 2 FPEF scores [1−yr] , which was independently associated with higher risk of AF recurrence rate after AFCA.   Clinical Trial Registration:  ClinicalTrials.gov  Identifier: NCT02138695.

One-Year Change in the H2FPEF Score After Catheter Ablation of Atrial Fibrillation in Patients With a Normal Left Ventricular Systolic Function