Arrhythmias & electrophysiologySecondary analysis
Effects of Atrial Fibrillation Ablation on Arrhythmia Burden and Ventricular Function in End-Stage Heart Failure: Lessons from CASTLE-HTx
- Secondary analysis of the CASTLE-HTx randomised trial
Authors' conclusion
Atrial fibrillation ablation in end-stage HF leads to a substantial decrease in AF burden, a regression from persistent to paroxysmal AF and notably improved LVEF.
Study context
- Population
- Patients with end-stage heart failure (HF) and atrial fibrillation (AF)97 received ablation
- Participants
- 194 patients
- Comparison
- AF ablation and medical therapy vs medical therapy alone
- Ablationn = 97
- Primary endpoint
- AF burden, arrhythmia recurrences and ventricular function (LVEF) after catheter ablation
- Follow-up
- 12 months
Primary result
As reported in the abstract
Effects of ablation (ablation group)
| Group | Persistent AF at 12 months | Median AF burden reduction | Left ventricular ejection fraction (LVEF) baseline → 12 months |
|---|---|---|---|
| Ablation | 31/89 (34.8%) | 36.3 (IQR 13.6-63.3) percentage points | 29.2 ± 6.2% to 39.1 ± 8.3% |
- Persistent AF significantly less frequent than at baseline
- P = 0.0001
- LVEF improved after ablation
- P < 0.001
Further findings
- Ablation procedure and atrial substrate
- 66 (68%) · pulmonary vein isolation (PVI) only · PVI plus additional ablation 31 (32%) · Left atrial low voltage >10% 31 (31.9%)
AF burden reduction <50% and LVEF improvement ≥5% · 12 months
- AF burden reduction <50% significantly associated with LVEF improvement ≥5%
- P = 0.017
Original publication
Effects of Atrial Fibrillation Ablation on Arrhythmia Burden and Ventricular Function in End-Stage Heart Failure: Lessons from CASTLE-HTx. Eur J Heart Fail. Published 24 October 2024. doi:10.1002/ejhf.3505
Summarised from the published abstract; every number is checked against it