Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation - CASTLE-AF

Feb 02, 2018
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Biotronik
Date Presented:
08/27/2017
Date Published:
02/01/2018
Date Updated:
02/02/2018
Original Posted Date:
08/27/2017
References

Contribution To Literature:

The CASTLE-AF trial showed that catheter ablation was superior at preventing death or heart failure admissions.

Description:

The goal of the trial was to evaluate catheter ablation compared with standard treatment among patients with left ventricular dysfunction and atrial fibrillation.

Study Design

  • Randomized
  • Parallel

Patients with left ventricular dysfunction and atrial fibrillation were randomized to catheter ablation (n = 179) versus conventional treatment (n = 184).

  • Total number of enrollees: 363
  • Duration of follow-up: median 37.8 months
  • Mean patient age: 64 years
  • Mean left ventricular ejection fraction: 35%

Inclusion criteria:

  • Symptomatic paroxysmal or persistent atrial fibrillation
  • Intolerance or unwillingness to take at least one antiarrhythmic drug
  • Left ventricular ejection fraction: ≤35%
  • New York Heart Association class ≥2
  • Implantable cardioverter-defibrillator or cardiac resynchronization therapy-defibrillator with home monitoring capabilities

Principal Findings:

The primary outcome, incidence of death or hospitalization for heart failure, occurred in 28.5% of the catheter ablation group vs. 44.6% of the control group (p = 0.007).

  • All-cause mortality: 13.4% with catheter ablation vs. 25.0% with control (p = 0.01)
  • Hospitalization for heart failure: 20.7% with catheter ablation vs. 35.9% with control (p = 0.004)

Interpretation:

Among patients with left ventricular dysfunction and atrial fibrillation, catheter ablation was superior to conventional treatment. Catheter ablation was associated with a reduction in deaths or hospitalizations for heart failure.

References:

Marrouche NF, Brachmann J, Andresen D, et al., on behalf of the CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation With Heart Failure. N Engl J Med 2018;Feb 1:[Epub ahead of print].

Editorial: Link MS. Paradigm Shift for Treatment of Atrial Fibrillation in Heart Failure. N Engl J Med 2018;Feb 1:[Epub ahead of print].

Presented by Dr. Nassir Marrouche at the European Society of Cardiology Congress, Barcelona, Spain, August 27, 2017.

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Cardiac Resynchronization Therapy Devices, Defibrillators, Implantable, ESC Congress, ESC2017, Heart Failure, Primary Prevention, Stroke Volume, Ventricular Dysfunction, Left


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