Arrhythmias & electrophysiologySecondary analysis
Catheter ablation in end-stage heart failure with atrial fibrillation: an hierarchical endpoint analysis of the CASTLE-HTx trial
- Secondary analysis of the CASTLE-HTx randomised trial
- generalized pairwise comparison
- hierarchical endpoint
Authors' conclusion
This pairwise analysis of CASTLE-HTx confirms the clinical benefits of early catheter ablation in addition to GDMT among AF patients in end-stage HF. The treatment benefit was primarily driven by mortality and HF hospitalizations.
Study context
- Population
- Patients with end-stage heart failure (HF) and atrial fibrillation (AF)
- Participants
- 194 patients
- Comparison
- Catheter ablation + guideline-directed medical therapy (GDMT) vs medical therapy alone
- Ablationn = 97
- Medical therapyn = 97reference
Primary result
As reported in the abstract
First hierarchical outcome · 3 years
- Ablation
- restricted net treatment benefit (NTB) 35.3% (95% CI 19.8–49.0); P < 0.001
- Ablation
- win odds 2.09 (95% CI 1.49–2.92)
- Tied pairs
- 12.0%
Further findings
Secondary hierarchical analysis (incl. AF burden and LVEF improvement) · values = % of pairs favouring each group
restricted NTB 38.4% (22.8–52.0) · P < 0.001
| Outcome | win odds (95% CI) | P value |
|---|---|---|
| Secondary hierarchical analysis (incl. AF burden and LVEF improvement) · values = % of pairs favouring each group | 2.25 (1.59–3.17) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Catheter ablation in end-stage heart failure with atrial fibrillation: an hierarchical endpoint analysis of the CASTLE-HTx trial. Eur J Heart Fail. Published 30 July 2026. doi:10.1093/ejhf/xuag223
Summarised from the published abstract; every number is checked against it