6,11,18,19 We initiated the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial to address this issue. 13-17 Nevertheless, the effectiveness of catheter ablation in improving rates of hard primary end points such as death or the progression of heart failure has not been tested in large, randomized, controlled trials, and guidelines provide no clear consensus regarding the best management approach. 7 Catheter ablation is a well-established option for symptomatic atrial fibrillation that is resistant to drug therapy in patients with otherwise normal cardiac function, 8-12 and various studies have shown that ablation is associated with positive outcomes in patients with heart failure. Rhythm control with antiarrhythmic drugs is not superior to rate control in patients with coexisting heart failure and atrial fibrillation. 3-6 Although the treatment of atrial fibrillation can substantially alter long-term outcomes in patients with heart failure, the subject of what is the most effective management strategy is debated. (Funded by Biotronik CASTLE-AF number, NCT00643188.) IntroductionĪtrial fibrillation and heart failure are common coexisting conditions, 1,2 with atrial fibrillation increasing the risk of stroke, hospitalization for heart failure, and death. ConclusionsĬatheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. 46 hazard ratio, 0.53 95% CI, 0.32 to 0.86 P=0.01), were hospitalized for worsening heart failure (37 vs. Significantly fewer patients in the ablation group died from any cause (24 vs. ResultsĪfter a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients vs. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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