Atrial Fibrillation Ablation Is Effective in Patients With End-stage Heart Failure

Atrial fibrillation ablation is linked to lower rates of mortality and a decreased need for urgent heart transplantation or left ventricular assist device (LVAD) implantation compared with medical therapy in patients with end-stage heart failure, according to a study presented at the European Society of Cardiology Congress 2023.

Researchers in the CASTLE-HTx trial assessed whether atrial fibrillation ablation is superior to medical therapy in regard to mortality and need for urgent transplantation or LVAD implantation. The study comprised 194 patients (average age, 64 years; 19% women).

The study subjects were randomly assigned 1:1 to receive either first-time catheter ablation or medical therapy for atrial fibrillation. Both groups received guideline-directed heart failure therapy, the researchers noted. The study’s primary end point was the composite of all-cause mortality and worsening heart failure requiring urgent heart transplantation or implantation of an LVAD.

According to the results, the primary end point occurred in just over 8% of patients in the ablation group and almost 30% of patients in the medical therapy group (hazard ratio, 0.24). “Comparing atrial fibrillation ablation with medical therapy in patients with end-stage heart failure, ablation was associated with lower rates of death [and] urgent heart transplantation or LVAD implantation, along with a reduction in atrial fibrillation burden and improved [left ventricular ejection fraction]. Of note, listing for transplantation should not be postponed given the long wait times and high waitlist mortality,” said the study’s Principal Investigator Christian Sohns, of the Heart and Diabetes Center NRW in Germany, in a press release.