CASTLE-AF
Trial question
What is the role of catheter ablation for AF in patients with HF who are otherwise receiving appropriate treatment?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
14.0% female
86.0% male
N = 363
363 patients (52 female, 311 male).
Inclusion criteria: patients with symptomatic paroxysmal or persistent AF and HF who did not respond to antiarrhythmic drugs.
Key exclusion criteria: candidacy for heart transplantation or planned cardiovascular intervention.
Interventions
N=179 catheter ablation (to restore sinus rhythm).
N=184 medical therapy alone (for rate or rhythm control).
Primary outcome
Death or hospitalization for worsening HF
28.5%
44.6%
44.6 %
33.5 %
22.3 %
11.2 %
0.0 %
Catheter
ablation
Medical therapy
alone
Significant
decrease ▼
NNT = 6
Significant decrease in death or hospitalization for worsening HF (28.5% vs. 44.6%; HR 0.62, 95% CI 0.43 to 0.87).
Secondary outcomes
Significant decrease in death from any cause (13.4% vs. 25%; HR 0.53, 95% CI 0.32 to 0.86).
Significant decrease in hospitalization for worsening HF (20.7% vs. 35.9%; HR 0.56, 95% CI 0.37 to 0.83).
Significant decrease in CV death (11.2% vs. 22.3%; HR 0.49, 95% CI 0.29 to 0.84).
Safety outcomes
Significant differences in pericardial effusion and severe bleeding (3 vs. 0 in each),.
Conclusion
In patients with symptomatic paroxysmal or persistent AF and HF who did not respond to antiarrhythmic drugs, catheter ablation was superior to medical therapy alone with respect to death or hospitalization for worsening HF.
Reference
Marrouche NF, Brachmann J, Andresen D et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417-427.
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