Catheter ablation for atrial fibrillation with heart failure

Nassir F. Marrouche, Johannes Brachmann, Dietrich Andresen, Jürgen Siebels, Lucas Boersma, Luc Jordaens, B. Merkely, Evgeny Pokushalov, Prashanthan Sanders, Jochen Proff, Heribert Schunkert, Hildegard Christ, Jürgen Vogt, Dietmar Bänsch

Research output: Contribution to journalArticle

306 Citations (Scopus)

Abstract

BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188.)

Original languageEnglish
Pages (from-to)417-427
Number of pages11
JournalNew England Journal of Medicine
Volume378
Issue number5
DOIs
Publication statusPublished - Feb 1 2018

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Catheter Ablation
Atrial Fibrillation
Heart Failure
Confidence Intervals
Cause of Death
Hospitalization
Defibrillators
Anti-Arrhythmia Agents
Therapeutics
Stroke Volume
Guidelines
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Marrouche, N. F., Brachmann, J., Andresen, D., Siebels, J., Boersma, L., Jordaens, L., ... Bänsch, D. (2018). Catheter ablation for atrial fibrillation with heart failure. New England Journal of Medicine, 378(5), 417-427. https://doi.org/10.1056/NEJMoa1707855

Catheter ablation for atrial fibrillation with heart failure. / Marrouche, Nassir F.; Brachmann, Johannes; Andresen, Dietrich; Siebels, Jürgen; Boersma, Lucas; Jordaens, Luc; Merkely, B.; Pokushalov, Evgeny; Sanders, Prashanthan; Proff, Jochen; Schunkert, Heribert; Christ, Hildegard; Vogt, Jürgen; Bänsch, Dietmar.

In: New England Journal of Medicine, Vol. 378, No. 5, 01.02.2018, p. 417-427.

Research output: Contribution to journalArticle

Marrouche, NF, Brachmann, J, Andresen, D, Siebels, J, Boersma, L, Jordaens, L, Merkely, B, Pokushalov, E, Sanders, P, Proff, J, Schunkert, H, Christ, H, Vogt, J & Bänsch, D 2018, 'Catheter ablation for atrial fibrillation with heart failure', New England Journal of Medicine, vol. 378, no. 5, pp. 417-427. https://doi.org/10.1056/NEJMoa1707855
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L et al. Catheter ablation for atrial fibrillation with heart failure. New England Journal of Medicine. 2018 Feb 1;378(5):417-427. https://doi.org/10.1056/NEJMoa1707855
Marrouche, Nassir F. ; Brachmann, Johannes ; Andresen, Dietrich ; Siebels, Jürgen ; Boersma, Lucas ; Jordaens, Luc ; Merkely, B. ; Pokushalov, Evgeny ; Sanders, Prashanthan ; Proff, Jochen ; Schunkert, Heribert ; Christ, Hildegard ; Vogt, Jürgen ; Bänsch, Dietmar. / Catheter ablation for atrial fibrillation with heart failure. In: New England Journal of Medicine. 2018 ; Vol. 378, No. 5. pp. 417-427.
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AU - Marrouche, Nassir F.

AU - Brachmann, Johannes

AU - Andresen, Dietrich

AU - Siebels, Jürgen

AU - Boersma, Lucas

AU - Jordaens, Luc

AU - Merkely, B.

AU - Pokushalov, Evgeny

AU - Sanders, Prashanthan

AU - Proff, Jochen

AU - Schunkert, Heribert

AU - Christ, Hildegard

AU - Vogt, Jürgen

AU - Bänsch, Dietmar

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N2 - BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188.)

AB - BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188.)

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