Universität zu Köln

Marrouche, Nassir F., Brachmann, Johannes, Andresen, Dietrich, Siebels, Juergen, Boersma, Lucas, Jordaens, Luc ORCID: 0000-0002-1407-7186, Merkely, Bela, Pokushalov, Evgeny, Sanders, Prashanthan ORCID: 0000-0003-3803-8429, Proff, Jochen, Schunkert, Heribert, Christ, Hildegard ORCID: 0000-0003-3235-2994, Vogt, Juergen and Baensch, Dietmar (2018). Catheter Ablation for Atrial Fibrillation with Heart Failure. N. Engl. J. Med., 378 (5). S. 417 - 428. WALTHAM: MASSACHUSETTS MEDICAL SOC. ISSN 1533-4406

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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.)

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Marrouche, Nassir F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brachmann, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Andresen, Dietrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Siebels, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Boersma, Lucas UNSPECIFIED UNSPECIFIED UNSPECIFIED Jordaens, Luc UNSPECIFIED orcid.org/0000-0002-1407-7186 UNSPECIFIED Merkely, Bela UNSPECIFIED UNSPECIFIED UNSPECIFIED Pokushalov, Evgeny UNSPECIFIED UNSPECIFIED UNSPECIFIED Sanders, Prashanthan UNSPECIFIED orcid.org/0000-0003-3803-8429 UNSPECIFIED Proff, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Schunkert, Heribert UNSPECIFIED UNSPECIFIED UNSPECIFIED Christ, Hildegard UNSPECIFIED orcid.org/0000-0003-3235-2994 UNSPECIFIED Vogt, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Baensch, Dietmar UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-196667
DOI:	10.1056/NEJMoa1707855
Journal or Publication Title:	N. Engl. J. Med.
Volume:	378
Number:	5
Page Range:	S. 417 - 428
Date:	2018
Publisher:	MASSACHUSETTS MEDICAL SOC
Place of Publication:	WALTHAM
ISSN:	1533-4406
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; VENTRICULAR SYSTOLIC DYSFUNCTION; PULMONARY-VEIN ISOLATION; RADIOFREQUENCY ABLATION; ANTIARRHYTHMIC-DRUGS; RHYTHM ASSOCIATION; 1ST-LINE TREATMENT; AMERICAN-COLLEGE; EUROPEAN-SOCIETY; RANDOMIZED-TRIAL Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19666