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CASTLE-AF: Catheter ablation confers improved outcomes for HF, AF
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Patients with atrial fibrillation and left ventricular dysfunction who underwent catheter ablation had improved outcomes compared with those who received conventional drug treatment, according to the CASTLE-AF study presented at the European Society of Cardiology Congress.
“This clinical trial sheds light on the importance of restoring and maintaining regular heart rhythm with ablation,” Nassir F. Marrouche, MD, professor of internal medicine in the Comprehensive Arrhythmia Research and Management Centre at University of Utah Health in Salt Lake City, said in a press release.
Researchers analyzed data from 397 patients with symptomatic persistent or paroxysmal AF who failed or were intolerant of at least one antiarrhythmic drug or were unwilling to take the medication. Patients had LV ejection fraction ≤ 35%.
After a run-in period, patients were assigned to undergo radiofrequency catheter ablation (n = 179; mean age, 64 years) or receive conventional drug treatment (n = 184; mean age, 64 years). Follow-up was conducted for a median of 37.8 months.
The primary endpoint was a composite of all-cause mortality and worsening HF hospital admissions. Secondary endpoints included events such as all-cause mortality, hospitalization for worsening HF, CV mortality and all-cause hospitalization.
“All of these patients had [implantable cardioverter defibrillators] implanted prior to inclusion in this study, so we had a lot of data that we looked at in terms of [AF] burden,” Marrouche said in the presentation.
During follow-up, 28.5% of patients in the ablation group had met the primary endpoint vs. 44.6% in the control group (HR = 0.62; 95% CI, 0.43-0.87). Instances of the secondary endpoints were also lower in the ablation group compared with the control group.
All-cause mortality occurred in 13.4% of patients in the ablation group vs. 25% in the control group (HR = 0.53; 95% CI, 0.32-0.86). HF hospitalization occurred in 20.7% of patients assigned ablation and 35.9% of those assigned conventional treatment (HR = 0.56; 95% CI, 0.37-0.83).
“The findings of CASTLE-AF will help not only save the lives of many patients suffering from [HF] and [AF], but will also have a major impact on the cost of treating those patients by keeping them out of hospital,” Marrouche said in the press release. – by Darlene Dobkowski
Reference:
Marrouche NF, et al. Late Breaking Clinical Trials 1. Presented at: European Society of Cardiology Congress; August 26-30, 2017; Barcelona, Spain.
Disclosure: The study was funded by Biotronik GmbH. Marrouche reports that he is a consultant, stockholder, owner and has received royalties from Abbott, Biosense Webster, Biotronik, Boston Scientific, Cardiac Design, Marrek Inc., Medtronic, Preventice, Vytronus and Wavelet Health, and has research contracts with Abbott, Biosense Webster, Biotronik, Boston Scientific, GE Healthcare, Siemens and Vytronus.