BOSTON – From the earliest days of using catheter ablation to treat atrial fibrillation (AF), in the 1990s, clinicians have defined ablation success based on whether patients had recurrence of their arrhythmia following treatment. New findings suggest that this standard was off, and that
The new study used data collected in the CASTLE-AF (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF) multicenter trial, which compared the efficacy of AF ablation with antiarrhythmic drug treatment in patients with heart failure for improving survival and freedom from hospitalization for heart failure. The trial’s primary finding showed that, in 363 randomized patients, AF ablation cut the primary adverse event rate by 38% relative to antiarrhythmic drug therapy (New Engl J Med. 2018 Feb 1;378[5]:417-27)
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Dr. Johannes Brachmann
“There have been concerns about the high recurrence rate of AF following ablation,” with reported cumulative recurrence rates running as high as 80% by 5 years after ablation, noted Dr. Brachmann. “The news now is that recurrence alone doesn’t make a difference; we can still help patients” by reducing their AF burden, although he cautioned that this relationship has so far only been seen in patients with heart failure with reduced ejection fraction, the type of patients enrolled in CASTLE-AF.
“This information is very informative for clinicians counseling patients who undergo ablation. Ablation may not eliminate all of a patient’s AF, but it will substantially reduce it, and that’s associated with better outcomes,” commented Andrew D. Krahn, MD, professor and chief of cardiology at the University of British Columbia in Vancouver. “Early on using ablation, we had a curative approach and used ablation to ‘clip the wire.’ Now we have growing, objective evidence for ‘debulking’ the problem” working without the need to completely eliminate all AF episodes.
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Dr. Andrew D. Krahn
To run the post hoc analysis Dr. Brachmann and his associates categorized the 363 patients randomized in CASTLE-AF by the treatment they received during the study’s first 12 weeks: 150 patients underwent catheter ablation, and 210 received drug treatment, with three patients dropping out. Although this division of the patients diverged from the randomized subgroups, the ablated and drug-treated patients showed no significant differences when compared for several clinical parameters.