Among heart failure patients with atrial fibrillation (AFib), catheter ablation is associated with more significant improvements in left ventricular ejection fraction (LVEF) than pharmacological treatment, according to new findings published in Circulation: Arrhythmia and Electrophysiology.
The authors performed a new analysis of data from the CASTLE-AF clinical trial, exploring the outcomes of 363 patients with coexisting heart failure and AFib. While 179 patients underwent catheter ablation, the remaining 184 patients received standard pharmacological therapy. Each patient’s left ventricular function and New York Heart Association (NYHA) class was tracked during follow-up assessments for up to five years.
Overall, the authors found that catheter ablation was linked to more substantial LVEF improvements than pharmacological therapy for all patients. The initial severity of the patient’s left ventricular (LV) dysfunction did not affect this association.
The researchers also confirmed that ablation was associated with “a significant decrease” in the composite endpoint of all-cause mortality and heart failure-related hospitalization—this was also independent of the initial severity of each patient’s LV dysfunction.
Another key takeaway from the group’s analysis is that the benefits of catheter ablation for AFib were “almost exclusively seen among patients with lower NYHA classes, whereas no significant difference in event rates was observed for patients with NYHA class III or IV.”
“This can be explained by the fact that higher NYHA classes are associated with increased profibrotic markers, atrial remodeling, and dysfunction compared with lower functional classes, limiting their benefit from ablation therapy,” wrote lead author Christian Sohns, MD, of the Ruhr-University Bochum in Germany, and colleagues. “Consequently, our data suggest performing catheter ablation before the progression of heart failure symptoms, independent of LV dysfunction severity.”
Read the study in full here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.