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CASTLE-AF Results Published in the New England Journal of Medicine, showing Mortality Reduction for Heart Failure Patients

Authors say Catheter Ablation of Atrial Fibrillation Now an Integral Treatment Option for Heart Failure Patients

The CASTLE-AF study—described as “potentially guideline-changing”, has been published in the New England Journal of Medicine .1 The trial, conducted with BIOTRONIK’s support, shows a 38 percent reduction in the composite endpoint of all-cause mortality and hospitalization for worsening heart failure, when catheter ablation is used to treat heart failure patients with atrial fibrillation (AF). This reduction was observed when compared to patients treated with the pharmacological therapy recommended by current guidelines.

“As the first AF catheter ablation study to confirm a positive composite endpoint of mortality and morbidity at a mean follow-up of more than three years, we expect CASTLE-AF to be a widely-discussed study, particularly with how it may change treatment guidelines,” says Dr. Nassir Marrouche, CARMA Center, University of Utah, Salt Lake City, US, who led the trial along with Dr. Johannes Brachmann, Coburg Clinic, Germany. “These findings indicate heart failure patients with coexisting AF should be treated with catheter ablation as a first-line therapy,” Dr. Brachmann says. “The data suggests the procedure should be performed as early as possible to achieve ideal results,” said Marrouche.

All patients enrolled in the study had ICDs or CRT-Ds with BIOTRONIK Home Monitoring® technology implanted. “We’re proud to have further developed options for Heart Failure patients with our clinical contributions, alongside our technological innovations,” said Thomas Simmerer, Managing Director at BIOTRONIK. “CASTLE-AF joins our IN-TIME2 and TRUECOIN3 studies in demonstrating successful ways to reduce mortality in heart failure patients. We’re always striving to make care better and enhance well-being for our patients worldwide and our study contributions are an integral part of that.”


1Marrouche NF et al. N Engl J Med. 2018, 378.

2Hindricks G et al. Lancet. 2014, 384 (9943).

3Hindricks G et al. European Heart Journal. 2017, May 10. doi:



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