Three-Year Outcomes of Catheter Ablation in Patients With End-Stage Heart Failure and Atrial Fibrillation

ASTLE-HTx (Catheter Ablation for Atrial Fibrillation in Patients With End-Stage Heart Failure and Eligibility for Heart Transplantation; URL: https:// www.clinicaltrials.gov;Unique identifier: NCT04649801) showed that the combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device (LVAD), or heart transplantation (HTx) in patients with end-stage heart failure (HF) and atrial fibrillation (AF) than medical therapy alone.1 The median follow-up of the original report was 18 months.This study sought to report the full 3-year outcomes of CASTLE-HTx by intention-to-treat.We randomized 194 patients in end-stage HF and AF to receive catheter ablation and guideline-directed medical therapy (n=97) or medical therapy alone (n=97).Details of the study design, outcome definitions, and results have been published.1-4 The primary end point was a composite of death from any cause, HTx, or LVAD implantation.The secondary end points included the components of the primary end point, death from cardiovascular causes, unplanned hospitalizations, left ventricular ejection fraction, AF burden, and the type of AF at 36 months.The trial was approved by the institutional review board at the Ruhr-Universität Bochum and conformed to the principles of the Declaration of Helsinki.Patients gave written informed consent.