ESC 2023 — We are joined onsite by Prof Christian Sohns and Prof Philipp Sommer (Heart and Diabetes Centre, Bad Oyenhausen, DE) to discuss the findings from the CASTLE-HTx trial (NCT04649801).

CASTLE-HTx (Heart and Diabetes Center North-Rhine Westfalia) aimed to determine if atrial fibrillation ablation has beneficial effects on mortality in patients with end-stage heart failure, who are eligible for a heart transplant. 194 patients were enrolled in the trial, who were randomized to receive either conventional treatment, or catheter ablation treatment. The primary endpoint included the composite of all-cause mortality, worsening of heart failure requiring an urgent transplantation, or left-ventricular assist device implantation.

Results showed that atrial fibrillation ablation was associated with lower rates of death, urgent heart transplantation or LVAD implantation when compared to medical therapy in patients with end-stage heart failure. Findings also suggested a reduction in atrial fibrillation, and an improved left ventricular ejection fraction.

Questions:

1. What are the unmet needs of end-stage HF patients?
2. What was the patient population and study design?
3. What were the key findings?
4. What should be the impact of these findings on clinical practice?
5. What further study is still required?

Recorded on-site at ESC Congress 2023, Amsterdam. 

Editors: Mirjam Boros and Jordan Rance
Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles