The secondary endpoints of all-cause mortality and heart failure hospitalisation were also significantly lower with catheter ablation compared to conventional treatment. Rates of all-cause mortality were 13.4% with catheter ablation versus 25% with conventional treatment (HR, 0.53; 95% CI, 0.32–0.86; p=0.011). Rates of heart failure hospitalisation were 20.7% with catheter ablation versus 35.9% with conventional treatment (0.56; 95% CI, 0.37-0.83; P=0.004).
Prof Marrouche said: “We found that compared to those receiving conventional treatment, patients receiving catheter ablation were 38% less likely to experience the primary endpoint, 47% less likely to die, and 44% less likely to be hospitalised with worsening heart failure. A significant number of patients undergoing the ablation treatment were still in normal rhythm at the end of the study.”
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Prof Marrouche added that the study also had limitations, namely the fact that all patients had a previous ICD implanted, and this may have affected mortality in both groups.
“Nevertheless, this clinical trial sheds light on the importance of restoring and maintaining regular heart rhythm with ablation,” added Prof Marrouche.
“Until now we had no evidence that ablation, arrhythmia medications, or any other treatment was superior to another in saving lives and reducing hospitalisation,” said Prof Brachmann. “This study has the potential to change the way physicians manage many patients suffering from heart failure and atrial fibrillation.”
Prof Marrouche concluded: “The findings of CASTLE-AF will help not only save the lives of many patients suffering from heart failure and atrial fibrillation but will also have a major impact on the cost of treating those patients by keeping them out of hospital.”
Sources of funding: The study was sponsored mostly by Biotronik GmbH.
Disclosures: Ownership Interest in Marrek, Inc., Cardiac Designs. Contracted Research with Biosense Webster, Medtronic, St Jude Medical, Boston Scientific. Consulting fees from Biotronik, Preventice.
About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 140 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About ESC Congress 2017
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2017 takes place 26 to 30 August at the Fira Gran Via in Barcelona, Spain. The scientific programme is here.
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