Catheter ablation for atrial fibrillation in patients with end‐stage heart failure and eligibility for heart transplantation

Abstract

Aims Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). The purpose of the Catheter Ablation for atrial fibrillation in patientS with end-sTage heart faiLure and Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the hypothesis that atrial fibrillation (AF) ablation has beneficial effects on mortality and morbidity during 'waiting time' for heart transplantation (HTx) or to prolong the time span until LVAD implantation. Methods and Results CASTLE-HTx is a randomized evaluation of ablative treatment of AF in patients with severe left ventricular dysfunction who are candidates and eligible for HTx. The primary endpoint is the composite of all-cause mortality, worsening of HF requiring a high urgent transplantation, or LVAD implantation. The secondary study endpoints are all-cause mortality, cardiovascular mortality, cerebrovascular accidents, worsening of HF requiring unplanned hospitalization, AF burden reduction, unplanned hospitalization due to cardiovascular reason, all-cause hospitalization, quality of life, number of delivered implantable cardioverter defibrillator therapies, time to first implantable cardioverter defibrillator therapy, number of device-detected ventricular tachycardia/ventricular fibrillation episodes, left ventricular function, exercise tolerance, and percentage of right ventricular pacing. Ventricular myocardial tissue will be obtained from patients who will undergo LVAD implantation or HTx to assess the effect of catheter ablation on human HF myocardium. CASTLE-HTx will randomize 194 patients over a minimum time period of 2 years. Conclusions CASTLE-HTx will determine if AF ablation has beneficial effects on mortality in patients with end-stage HF who are eligible for HTx.

News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

“…As CB-guided single-shot PVI is associated with shorter procedure times, an improved learning curve and a higher degree of lesion reproducibility it provides a valid alternative to radiofrequency (RF)-guided catheter ablation [1, [4][5][6][7]. Over the past 15 years, much experience has been gained with the established AFA-CB (Arctic Front Advance (Pro), AFA, Medtronic) [1, 5,[8][9][10][11][12][13].…”

Impact of pulmonary vein variant anatomy and cross-sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single-shot guided pulmonary vein isolation

“…Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF) [1][2][3][4][5]. In addition, it is an alternative to radiofrequency (RF)-guided catheter ablation, due to shorter procedure times, a steep learning curve, and a high degree of lesion reproducibility [1,[6][7][8].…”

The Role of Daily Implant-Based Multiparametric Telemonitoring in Patients with a Ventricular Assist Device

“…This tool may allow pre-emptive or early interventions, e.g., medication adjustments, device reprogramming and hospital admissions, including device/lead revisions, as well as VA-ablation procedures ( Table 2 and Table 3 , Figure 4 ). Prior studies, reporting on the feasibility, safety and efficacy of catheter ablations for VAs in third-generation VAD patients [ 5 , 19 ] and for AT/AF in end-stage HF patients strengthen these therapeutic options through rapid identification [ 20 ].…”