Atrial Fibrillation Burden and Clinical Outcomes in Heart Failure: The CASTLE-AF Trial.

Brachmann, Johannes; Sohns, Christian; Andresen, Dietrich; Siebels, Jürgen; Sehner, Susanne; Boersma, Luca; Merkely, Béla; Pokushalov, Evgeny; Sanders, Prashanthan; Schunkert, Heribert; Bänsch, Dietmar; Dagher, Lilas; Zhao, Yan; Mahnkopf, Christian; Wegscheider, Karl; Marrouche, Nassir F

doi:10.1016/j.jacep.2020.11.021

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Title:: Atrial Fibrillation Burden and Clinical Outcomes in Heart Failure: The CASTLE-AF Trial.
Document type:: Article; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Author(s):: Brachmann, Johannes; Sohns, Christian; Andresen, Dietrich; Siebels, Jürgen; Sehner, Susanne; Boersma, Luca; Merkely, Béla; Pokushalov, Evgeny; Sanders, Prashanthan; Schunkert, Heribert; Bänsch, Dietmar; Dagher, Lilas; Zhao, Yan; Mahnkopf, Christian; Wegscheider, Karl; Marrouche, Nassir F
Abstract:: OBJECTIVES: This subanalysis of the CASTLE-AF (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF) trial aimed to address the association between atrial fibrillation (AF) recurrence, AF burden, and hard clinical outcomes in heart failure (HF) patients with AF. BACKGROUND: The CASTLE-AF trial demonstrated the benefit of CA compared to pharmacological treatment in decreasing mortality and CV hospitalizations in patients with AF and HFrEF. However, the impact of AF recurrence and AF burden after ablation on long-term treatment benefit remains unknown. METHODS: The CASTLE-AF protocol randomized 363 patients with coexisting HF and AF in a multicenter prospective controlled fashion to catheter ablation (n = 179) versus pharmacological therapy (n = 184). Two hundred eighty patients were included in this subanalysis (as-treated), 128 of them underwent ablation and 152 received pharmacological treatment. All patients had implanted dual chamber or biventricular implantable defibrillators with activated home monitoring capabilities. The individual AF burden was calculated as the percentage of the atrial arrhythmia time per day. RESULTS: AF burden at baseline was not predictive of the primary endpoint (p = 0.473) or all-cause mortality (p = 0.446). AF recurrence (defined as any episode >30 s) did not show any relationship with the primary endpoints of mortality and occurrence of HF, irrespective of the treatment arm. An AF burden below 50% after 6 months of catheter ablation, was associated with a significant decrease in primary composite outcome (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.15 to 0.71; p = 0.014) and all-cause mortality (HR: 0.23; 95% CI: 0.07 to 0.71; p = 0.031). The risk of the primary endpoint or mortality was directly related to a low (<50%) or high (≥50%) AF burden at 6 months post-ablation. CONCLUSIONS: AF burden at 6 months was predictive of hard clinical outcomes in HF patients with AF. The first recurrent atrial tachyarrhythmia episode >30 s after ablation was not associated with improvement in mortality and hospitalization for HF. (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF [CASTLE-AF]; NCT00643188).
Journal title abbreviation:: JACC Clin Electrophysiol
Year:: 2021
Journal volume:: 7
Journal issue:: 5
Pages contribution:: 594-603
Fulltext / DOI:: doi:10.1016/j.jacep.2020.11.021
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33640355
Print-ISSN:: 2405-500X
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2021