{"id":"6a0d59ff2d54","type":"article","url":"https://hartvaat.nl/2018/02/01/katheterablatie-bij-af-met-hartfalen-nejm-castle-af/","title":"Katheterablatie bij AF met hartfalen: NEJM CASTLE-AF","title_en":"Catheter Ablation for Atrial Fibrillation with Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1707855","source_url":"https://doi.org/10.1056/NEJMoa1707855","authors":["Nassir F Marrouche","Johannes Brachmann","Dietrich Andresen","Jürgen Siebels","Lucas Boersma","Luc Jordaens","Béla Merkely","Evgeny Pokushalov","Prashanthan Sanders","Jochen Proff","Heribert Schunkert","Hildegard Christ","Jürgen Vogt","Dietmar Bänsch"],"significance":10,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The CASTLE-AF trial showed that catheter ablation for atrial fibrillation significantly reduced the composite of death and heart failure hospitalization compared with medical therapy in patients with both AF and heart failure. This landmark result established ablation as a disease-modifying intervention in the AF-heart failure overlap population.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T18:38:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CASTLE-AF-trial die aantoonde dat katheterablatie voor AF de mortaliteit en HF-hospitalisatie significant vermindert bij patiënten met hartfalen. Game-changer voor AF-ablatie bij HF.","abstract_original":"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 medical-therapy 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 .)."}