Atrial fibrillation (AFib) ablation was associated with lower rates of death, urgent heart transplantation or left ventricular assist device (LVAD) implantation compared with medical therapy in patients with end-stage heart failure (HF), according to results from the CASTLE-HTx trial presented at ESC Congress 2023.

Researchers randomly assigned 194 patients (median age 64 years; 19% women) with symptomatic AFib and end-stage HF and who were eligible for heart transplantation to either first-time catheter ablation or medical therapy for AFib. All participants received guideline-directed HF therapy.

The primary endpoint, which was the composite of all-cause mortality, worsening HF requiring urgent heart transplantation, or implantation of an LVAD, occurred in 8.2% of patients in the ablation group compared with 29.9% of patients in the medical therapy group. The study was stopped for efficacy by the Data Safety Monitoring Board one year after randomization was completed.

"Comparing [AFib] ablation with medical therapy in patients with end-stage HF, ablation was associated with lower rates of death, urgent heart transplantation or LVAD implantation, along with a reduction in AFib burden and improved LVEF," said Christian Sohns, MD, of the Heart and Diabetes Center NRW, in Germany. "Of note, listing for transplantation should not be postponed given the long waiting times and high waitlist mortality."

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: ESC Congress, ESC23, ACC International, Catheter Ablation, Atrial Fibrillation, Heart Failure

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