{"id":"3b7630d56416","type":"article","url":"https://hartvaat.nl/2023/10/12/castle-htx-af-ablatie-bij-eindstadium-hartfalen-nejm/","title":"CASTLE-HTx: AF-ablatie bij eindstadium hartfalen — NEJM","title_en":"Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfref","katheterablatie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2306037","source_url":"https://doi.org/10.1056/NEJMoa2306037","authors":["Christian Sohns","Henrik Fox","Nassir F Marrouche","Harry J G M Crijns","Angelika Costard-Jaeckle","Leonard Bergau","Gerhard Hindricks","Nikolaos Dagres","Samuel Sossalla","Rene Schramm","Thomas Fink","Mustapha El Hamriti","Maximilian Moersdorf","Vanessa Sciacca","Frank Konietschke","Volker Rudolph","Jan Gummert","Jan G P Tijssen","Philipp Sommer"],"significance":10,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"The CASTLE-HTx trial demonstrated that catheter ablation for atrial fibrillation in patients with end-stage heart failure (on LVAD or transplant waiting list) dramatically improved survival, with a 44% relative reduction in the composite of death, LVAD implantation, or urgent heart transplantation. The results extend the benefit of AF ablation to the most severely ill heart failure patients.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T18:39:06Z","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":"De CASTLE-HTx-trial in de NEJM toonde dat catheterablatie voor AF bij eindstadium hartfalen (LVAD/transplantatielijst) de overleving spectaculair verbeterde. De composiet van sterfte, LVAD-implantatie en urgente harttransplantatie werd met 44% verminderd.","abstract_original":"BACKGROUND: The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. METHODS: We conducted a single-center, open-label trial in Germany that involved patients with symptomatic atrial fibrillation and end-stage heart failure who were referred for heart transplantation evaluation. Patients were assigned to receive 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. RESULTS: A total of 97 patients were assigned to the ablation group and 97 to the medical-therapy group. The trial was stopped for efficacy by the data and safety monitoring board 1 year after randomization was completed. 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 (interquartile range, 14.6 to 22.6), 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 (hazard ratio, 0.24; 95% confidence interval [CI], 0.11 to 0.52; P<0.001). Death from any cause occurred in 6 patients (6%) in the ablation group and in 19 patients (20%) in the medical-therapy group (hazard ratio, 0.29; 95% CI, 0.12 to 0.72). Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group. CONCLUSIONS: Among 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 a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone. (Funded by Else Kröner-Fresenius-Stiftung; CASTLE-HTx ClinicalTrials.gov number, NCT04649801.)."}