Atrial fibrillation and heart failure- results of the CASTLE-AF trial

Abstract

Congestive Heart Failure (HF) and Atrial Fibrillation (AFIB) often coexist. Catheter ablation is a well-established option for symptomatic AFIB that is resistant to drug therapy in patients with otherwise normal cardiac function. This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF. Recently, the study results from the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial were published. After a median follow-up of more than 3 years, patients getting catheter ablation for AFIB had significantly fewer hospital admissions as well as death from worsening HF. In addition, 63% of patients in the ablation group were in sinus rhythm, as compared with 22% of those in the medical-therapy group (P < 0.001). This trial may represent a significant additional therapeutic tool in the clinical prevention and management of cardiovascular mortality and morbidity. While catheter ablation does not eliminate the AFIB per se, it can limit the ventricular rate by eliminating triggers and altering electrophysiological connections in the heart in a similar fashion to rate control anti-arrhythmic drugs. Longer-duration normal sinus rhythm may improve outcomes by means of a number of mechanisms, including greater atrial emptying, all of which translate into improved cardiac output. A better understanding is needed as to why a decrease in density, but not complete elimination of atrial fibrillation, is sufficient for reverse remodelling. It is anticipated that the results of the CASTLE-AF trial will soon be implemented in international guidelines.

Gigantic arteriovenous fistula between left coronary cusp and coronary sinus draining into the right atrium

“…The closure of the fistula is recommended when it is symptomatic, while the treatment in asymptomatic patients remains controversial. Large coronary fistulas should be closed by transcatheter or surgical treatment, regardless of symptoms, while small to moderate size fistulas should be treated only if they cause symptoms [6][7][8][9]. Treatment for clinically significant CAF have focused on surgical management.…”

“…Treatment for clinically significant CAF have focused on surgical management. Since the first successful surgically treated CAF in 1947, several catheter-based interventional techniques have been developed including Tangential Arteriorrhaphy without the need for cardiopulmonary bypass (CPB), Transcatheter Embolization with various types of devices, and use of Covered Stents [7][8][9][10]. Despite the increasing use of these modalities, the intracardiac closure of the fistula by CPB with or without coronary artery bypass graft remains the standard method [8,11].…”

Three-year follow-up results of cryoablation of atrial fibrillation patients：A comparison of 1st-generation and 2nd-generation cryoballoons

“…Cryoballoon ablation have some advantages such as easy to learn 23,24 , improving the prognosis of AF patients combined with congestive heart failure 25 and maintaining the same efficiency among patients over and under 75years old 2 . CB2 has its advantages over CB1 such as shorter procedure duration and fluoroscopy time 3-5 and it's much easier to operate.…”

Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations

“…There are conflicting reports on the effect of rhythm or rate control treatment strategy for AF on neurocognitive decline. It is however an established fact that catheter ablation is a well-established option for symptomatic AF that is resistant to drug therapy [ 143 - 145 ]. The recent report from the CASTLE-AF (Catheter Ablation versus Standard Conventional Treatment in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) trial indicates that patients with HF and AF who undergo catheter ablation have better outcomes [ 144 - 146 ].…”