Christian Sohns1, Konstantin Zintl2, Yan Zhao3, Lilas Dagher3, Dietrich Andresen4, Jürgen Siebels5, Karl Wegscheider6, Susanne Sehner6, Lucas Boersma7, Béla Merkely8, Evgeny Pokushalov9, Prashanthan Sanders10, Heribert Schunkert11, Dietmar Bänsch12, Christian Mahnkopf2, Johannes Brachmann2, Nassir F Marrouche3. 1. Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany (C.S.). 2. Department of Cardiology, Klinikum Coburg, Germany (K.Z., C.M., J.B.). 3. Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.). 4. Kardiologie an den Ev. Elisabeth-Kliniken, Berlin, Germany (D.A.). 5. Electrophysiology Center Bremen, Germany (J.S.). 6. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (K.W., S.S.). 7. Department of Cardiology, Antonius Ziekenhuis Nieuwegein, the Netherlands (L.B.). 8. Department of Cardiology, Semmelweis Medical University, Budapest, Hungary (B.M.). 9. State Research Institute of Circulation Pathology, Novosibirsk, Russia (E.P.). 10. Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (P.S.). 11. Department of Cardiology, Deutsches Herzzentrum München, Munich, Germany (H.S.). 12. Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany (D.B.).
Abstract
BACKGROUND: Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. METHODS: The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. RESULTS: In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P<0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P=0.006), all-cause mortality (HR, 0.54; P=0.019), and cardiovascular hospitalizations (HR, 0.66; P=0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P<0.001; mortality: HR, 0.30; P=0.001). CONCLUSIONS: Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient's heart failure symptoms.
RCT Entities:
BACKGROUND: Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. METHODS: The CASTLE-AFpatients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. RESULTS: In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P<0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P=0.006), all-cause mortality (HR, 0.54; P=0.019), and cardiovascular hospitalizations (HR, 0.66; P=0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P<0.001; mortality: HR, 0.30; P=0.001). CONCLUSIONS: Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient's heart failure symptoms.
Authors: Christian Sohns; Nassir F Marrouche; Angelika Costard-Jäckle; Samuel Sossalla; Leonard Bergau; Rene Schramm; Uwe Fuchs; Hazem Omran; Kerstin Rubarth; Daniel Dumitrescu; Frank Konietschke; Volker Rudolph; Jan Gummert; Philipp Sommer; Henrik Fox Journal: ESC Heart Fail Date: 2020-12-13