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treatment (rhythm control or rate control) for
atrial fibrillation. The primary endpoint was
the composite of all-cause mortality and
unplanned hospitalization for worsening
heart failure.
During a median follow-up of 37.8 months,
the rate of the primary endpoint was
significantly lower in the ablation group
(28.5%) vs the control group (44.6%; hazard
ratio 0.62; 95% confidence interval 0.43–
0.87; P = .007).
The secondary endpoints of all-cause
mortality and heart failure hospitalization
were also significantly lower with catheter
ablation than with conventional treatment.
Rates of all-cause mortality were 13.4% with
catheter ablation vs 25% with conventional
treatment (hazard ratio 0.53; 95%
confidence interval 0.32–0.86; P = .011).
Rates of heart failure hospitalization were
20.7% with catheter ablation vs 35.9%
with conventional treatment (0.56; 95%
confidence interval 0.37–0.83; P = .004).
Dr. Marrouche noted that compared to
those receiving conventional treatment,
patients receiving catheter ablation were
38% less likely to experience the primary
endpoint, 47% less likely to die, and 44%
less likely to be hospitalized with worsening
heart failure. “A significant number of
patients undergoing ablation were still in
normal rhythm at the end of the study,” he
said.
Dr. Marrouche added that the study also
carried limitations, namely that all patients
had a previous implantable cardioverter
defibrillator implanted, which may have
affected mortality in both groups.
He said, “Nevertheless, this clinical trial
sheds light on the importance of restoring
and maintaining regular heart rhythm with
ablation.”
“The findings of CASTLE-AF will help
not only save the lives of many patients
suffering from heart failure and atrial
fibrillation but will also exert a major impact
on the cost of treating these patients by
keeping them out of hospital,” he said.
According to
stopafib.org, a patient-driven
information site about atrial fibrillation,
catheter ablation has evolved over time.
“The most frequent catheter ablation
done today is the radiofrequency catheter
ablation. It is typically some variation of
pulmonary vein isolation (PVI). The goal of
the procedure is to eliminate the irregular
heartbeat that research has shown typically
originates from the four pulmonary veins
and is most successful with paroxysmal
atrial fibrillation.”
PracticeUpdate Editorial Team
ESC 2017
15
VOL. 2 • NO. 2 • 2017