Practice Update: Cardiology

ESC 2017 15

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.”

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%

“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

VOL. 2 • NO. 2 • 2017