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Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation.

Authors :: Sohns C
Fox H
Marrouche NF
Crijns HJGM
Costard-Jaeckle A
Bergau L
Hindricks G
Dagres N
Sossalla S
Schramm R
Fink T
El Hamriti M
Moersdorf M
Sciacca V
Konietschke F
Rudolph V
Gummert J
Tijssen JGP
Sommer P
Source :: The New England journal of medicine [N Engl J Med] 2023 Oct 12; Vol. 389 (15), pp. 1380-1389. Date of Electronic Publication: 2023 Aug 27.
Publication Year :: 2023
Abstract: Background: The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown.<br />Methods: We conducted a single-center, open-label trial in Germany that involved patients with symptomatic atrial fibrillation and end-stage heart failure who were referred for heart transplantation evaluation. Patients were assigned to receive catheter ablation and guideline-directed medical therapy or medical therapy alone. The primary end point was a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation.<br />Results: A total of 97 patients were assigned to the ablation group and 97 to the medical-therapy group. The trial was stopped for efficacy by the data and safety monitoring board 1 year after randomization was completed. Catheter ablation was performed in 81 of 97 patients (84%) in the ablation group and in 16 of 97 patients (16%) in the medical-therapy group. After a median follow-up of 18.0 months (interquartile range, 14.6 to 22.6), a primary end-point event had occurred in 8 patients (8%) in the ablation group and in 29 patients (30%) in the medical-therapy group (hazard ratio, 0.24; 95% confidence interval [CI], 0.11 to 0.52; P<0.001). Death from any cause occurred in 6 patients (6%) in the ablation group and in 19 patients (20%) in the medical-therapy group (hazard ratio, 0.29; 95% CI, 0.12 to 0.72). Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group.<br />Conclusions: Among patients with atrial fibrillation and end-stage heart failure, the combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone. (Funded by Else Kröner-Fresenius-Stiftung; CASTLE-HTx ClinicalTrials.gov number, NCT04649801.).<br /> (Copyright © 2023 Massachusetts Medical Society.)