Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation

The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. 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 transpl...

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Veröffentlicht in:The New England journal of medicine 2023-10, Vol.389 (15), p.1380-1389
Hauptverfasser: Sohns, Christian, Fox, Henrik, Marrouche, Nassir F., Crijns, Harry J.G.M., Costard-Jaeckle, Angelika, Bergau, Leonard, Hindricks, Gerhard, Dagres, Nikolaos, Sossalla, Samuel, Schramm, Rene, Fink, Thomas, El Hamriti, Mustapha, Moersdorf, Maximilian, Sciacca, Vanessa, Konietschke, Frank, Rudolph, Volker, Gummert, Jan, Tijssen, Jan G.P., Sommer, Philipp
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Sprache:eng
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Zusammenfassung:The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. 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. 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
ISSN:0028-4793
1533-4406
DOI:10.1056/NEJMoa2306037