Catheter ablation beneficial to AF patients with end-stage heart failure

When combined with guideline-directed medical therapy, catheter ablation helps reduce the risk of adverse outcomes such as death, left ventricular assist device implantation, and urgent heart transplantation in patients with atrial fibrillation (AF) and end-stage heart failure, according to data from the CASTLE HTx study.

CASTLE HTx included 194 patients with symptomatic AF and end-stage heart failure who were referred for heart transplantation evaluation. These patients were assigned to receive catheter ablation and guideline-directed medical therapy (n=97) or medical therapy alone (n=97).

The primary endpoint was a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation. In total, 81 patients (84 percent) in the ablation group and in 16 (16 percent) in the medical-therapy group received catheter ablation.

Over a median follow-up of 18.0 months, significantly fewer patients in the ablation group than in the medical-therapy group had a primary endpoint event (8 percent vs 30 percent). Catheter ablation reduced the risk of the composite primary endpoint by 76 percent (hazard ratio, 0.24, 95 percent confidence interval [CI], 0.11–0.52; p<0.001).

Death from any cause was documented in 6 percent of patients in the ablation group and in 20 percent of those in the medical-therapy group (hazard ratio, 0.29, 95 percent CI, 0.12–0.72). Procedure-related complications occurred in three patients and in one, respectively.