Catheter Ablation Bests Drug Therapy for Treating AF

Treating atrial fibrillation (AF) with radiofrequency (RF) catheter ablation results in lower hospitalization and mortality rates than traditional drug therapies, claims a new study.

Researchers at the University of Utah (Salt Lake City, USA), Klinikum Coburg (Coburg, Germany), and other institutions participating in the CASTLE-AF trial randomized 397 patients suffering from symptomatic paroxysmal or persistent AF and a left ventricular ejection fraction (LVEF) lower than 35% to RF catheter ablation or conventional drug treatment. The primary endpoint was composite all-cause mortality and unplanned hospitalization for worsening heart failure.

The results showed that the primary endpoint was significantly lower in the ablation group (28.5%) than in the conventional drug treatment (44.6%) group over a follow-up period of 37.8 months. Secondary endpoints of all-cause mortality and heart failure hospitalization were also significantly lower in the catheter ablation group, compared to the conventional treatment group (13.4% versus 25% and 20.7% percent versus 35.9%, respectively). The study was presented at the European Society of Cardiology (ESC) annual conference, held during August 2017 in Barcelona (Spain).

“None of the traditional drug therapies are improving the patient's condition, a major medical dilemma when we see these patients in our clinics,” said Professor Nassir Marrouche, MD, executive director of the comprehensive arrhythmia research and management center at the University of Utah. “This clinical trial is the first time we can show with hard data that ablation is saving more lives than arrhythmia medications. It also lowers the cost of treating patients by keeping them out of hospital due to lower incidence of worsening heart failure.”

Cardiac catheter ablation procedures treat a variety of cardiac arrhythmias, especially supraventricular tachyarrhythmias such as AF, atrial flutter, and atrial tachycardia. The procedures involve advancing a catheter into the heart and selectively ablating certain areas of tissue in order to prevent the spread of electrical signals that give rise to the arrhythmia. The procedure is low-risk and usually takes 2-4 hours. It is most often performed in an electrophysiology or a cardiac catheterization lab, and is successful in about 90% of the people who have it.

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University of Utah
Klinikum Coburg