6/28/23, 12:04 AM CASTLE-AF Pathway Feedback Search Clinical Topics Home Studies CASTLE AF CASTLE AF Disease Disease Atrial fibrillation Heart failure Trial question What is the role of catheter ablation for AF in patients with HF who are otherwise receiving appropriate treatment? Study design Multi-center Open label RCT Population Characteristics of study participants 14.3% female N = 398 85.7% male 398 patients (52 female, 311 male) Inclusion criteria: patients with symptomatic paroxysmal or persistent AF and HF who did not respond to antiarrhythmic drugs Key exclusion criteria: candidacy for heart transplantation or planned cardiovascular intervention Interventions N=179 catheter ablation (to restore sinus rhythm) N=184 medical therapy alone (for rate or rhythm control) Primary outcome Death or hospitalization for worsening HF 44.6 % 44.6 https://web.pathway.md/studies/recbUTrx9UP6gzymr 1/2 6/28/23, 12:04 AM CASTLE-AF Pathway 33.5 % 28.5 22.3 % Significant decrease 11.2 % NNT = 6 0.0 % Catheter ablation Medical therapy alone Significant decrease in death or hospitalization for worsening HF (28.5% vs. 44.6%; HR 0.62, 95% CI 0.43 to 0.87) Secondary outcomes Significant decrease in death from any cause (13.4% vs. 25%; HR 0.53, 95% CI 0.32 to 0.86) Significant decrease in hospitalization for worsening HF (20.7% vs. 35.9%; HR 0.56, 95% CI 0.37 to 0.83) Significant decrease in cardiovascular death (11.2% vs. 22.3%; HR 0.49, 95% CI 0.29 to 0.84) Safety outcomes Significant differences in pericardial effusion and severe bleeding (3 vs. 0 in each),. Conclusion In patients with symptomatic paroxysmal or persistent AF and HF who did not respond to antiarrhythmic drugs, catheter ablation was superior to medical therapy alone with respect to death or hospitalization for worsening HF. Reference Marrouche NF, Brachmann J, Andresen D et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417-427. Open reference URL https://web.pathway.md/studies/recbUTrx9UP6gzymr 2/2