Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE

Abstract

Heart failure (HF) and AF frequently coexist and are involved in a vicious cycle of adverse pathophysiologic interactions. Applying treatment algorithms that have been validated in the general AF population to patients with AF and HF may be fraught with risks and lack effectiveness. While firm recommendations on using catheter ablation for AF do exist, the subset of patients also suffering from HF needs to be further evaluated. Observational data indicate that a significant number of ablation procedures are performed in patients with coexistent HF. Initial randomised data on outcomes are encouraging. Apart from sinus rhythm maintenance, benefits have been observed in terms of other significant endpoints, including left ventricular ejection fraction, quality of life, exercise capacity and hospital readmissions for HF. Limited existing data on survival are also promising. In the present article, observational and randomised studies along with current practice guidelines are summarised.

Atrial fibrillation ablation in heart failure with reduced ejection fraction

“…Guidelines recommend atrioventricular nodal ablation with pacing only when rate or rhythm control is not achievable by pharmacological therapy (Class IIa, Level of Evidence: B). Catheter ablation is currently the cornerstone of rhythm control approaches in AF patients with HFrEF [22]. Moreover, in the past 5 years, the technology and modality of catheter ablation have dramatically changed.…”