The New England Journal of MedicineCatheter Ablation in End-Stage Heart Failure with Atrial Fibrillation

Catheter Ablation Combined with Medical Therapy Reduces Death and Urgent Heart Transplantation

A recent study conducted in Germany has shed light on the potential benefits of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure. The findings suggest a significant improvement in patient outcomes when catheter ablation is combined with guideline-directed medical therapy.

HCN Medical Memo
The study reinforces the potential of catheter ablation as an effective treatment strategy for patients with atrial fibrillation and end-stage heart failure. The combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of death, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone. This could have significant implications for treatment protocols moving forward.

Study Design

• Single-center, open-label trial conducted in Germany.
• Involved patients with symptomatic atrial fibrillation and end-stage heart failure referred for heart transplantation evaluation.
• Patients were assigned to receive either catheter ablation and guideline-directed medical therapy or medical therapy alone.
• The primary end point was a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation.

Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting more than 33 million people worldwide.

Key Findings

• 97 patients were assigned to each group (ablation and medical-therapy).
• Catheter ablation was performed in 81 of 97 patients (84%) in the ablation group and in 16 of 97 patients (16%) in the medical-therapy group.
• After a median follow-up of 18.0 months, a primary end-point event had occurred in 8 patients (8%) in the ablation group and in 29 patients (30%) in the medical-therapy group.
• Death from any cause occurred in 6 patients (6%) in the ablation group and in 19 patients (20%) in the medical-therapy group.
• Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group.

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