Ablation ensures survival benefits in terminal heart failure

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In contrast to treatment with medication alone, patients benefit from additional catheter ablation, a new study shows.

Heart specialists from the Heart and Diabetes Center NRW (HDZ NRW), Bad Oeynhausen, have demonstrated for the first time worldwide in a monocentric, open study that patients suffering from severe heart failure (cardiac insufficiency) in combination with symptomatic atrial fibrillation benefit more from catheter ablation in combination with guideline-compliant drug therapy than from drug therapy alone. The scientific publication of the author panel consisting of electrophysiologists, cardiac surgeons and cardiologists under the leadership of Philipp Sommer and Christian Sohns, Clinic Director and Deputy Clinic Director of Electrophysiology/Rhythmology at the HDZ NRW, was published in the New England Journal of Medicine in August 2023 and was recently presented at the annual meeting of the European Society of Cardiology under the name ,,CASTLE-HTx2".

Treatment options for terminal heart failure

At the terminal heart failure stage, affected individuals are usually so debilitated that the heart’s pumping function is just enough to keep the body alive. Treatment options include drug therapy, implantation of artificial heart support, and heart transplantation. It is particularly important to keep cardiovascular function as stable as possible during sometimes long waiting periods for a donor organ, so that patients recover optimally after a transplant.

Thanks to state-of-the-art cardiac catheterization procedures and gentle ablation methods, even patients with end-stage heart failure can benefit from cardiac catheterization. The current study situation indicates an improved quality of life, especially in atrial fibrillation. The study initiated by Christian Sohns and Philipp Sommer has now for the first time scientifically investigated the significance of this intervention for patients who present to the HDZ NRW in Bad Oeynhausen for evaluation of the indication for possible heart transplantation due to their cardiac insufficiency.

Lower mortality risk and longer survival time

A total of 194 patients participated in the study, half of whom were assigned to an ablation group and half to a drug-therapeutic group. After an average follow-up period of 18 months, the results indicate a lower risk of mortality and longer survival to both implantation of an artificial heart assist device and heart transplantation in patients who underwent catheter ablation. Based on these findings, the scientists plan to follow up with further studies.

As a large center specializing in heart failure, the HDZ NRW provides us with comprehensive data material, which we now need to further expand in the direction of precisely these electrophysiological and interdisciplinary research areas," emphasizes Clinic Director Philipp Sommer. "In particular, we are interested in which individual forms of disease have the greatest benefit from ablation." Christian Sohns adds: "We are also particularly pleased that the study has met with great interest among international professional societies. From our point of view, it gives reason to reconsider the existing guidelines."

As a specialist clinic for the treatment of cardiovascular and diabetic diseases, the Heart and Diabetes Center North Rhine-Westphalia (HDZ NRW), Bad Oeynhausen, with 36,000 patients per year, is one of the largest and most modern centers of its kind in Europe. The interdisciplinary heart failure center of the HDZ NRW is designated as a supraregional center certified by the professional associations (HFU). Every year, 6,500 patients with cardiac insufficiency are treated here as inpatients.

The Clinic for Electrophysiology/Rhythmology of the HDZ NRW specializes in the treatment of cardiac arrhythmias with a service spectrum of around 1,700 ablations per year. Electrophysiological examinations are performed in the clinic using state-of-the-art, low-radiation technology for the treatment of arrhythmias.

With 104 intensive care beds (Krankenhausplan NRW), the overall hospital HDZ NRW has one of the largest intensive care bed capacities for the specialties thoracic and cardiovascular surgery as well as general and interventional cardiology and angiology. With 96 heart transplants in 2022, the HDZ NRW is the largest heart transplant center in Germany. Further focal points of the heart center are the treatment of the entire spectrum of congenital and acquired heart diseases including the therapy of cardiac arrhythmias as well as artificial heart support systems and artificial hearts.

The HDZ NRW has been a university hospital of the Ruhr University Bochum since 1989. The professorship of the HDZ NRW is additionally a member of the Medical Faculty OWL of the University of Bielefeld since 2023. The institution is known as the largest heart transplant center in Germany.

Christian Sohns et al: Catheter ablation in end-stage heart failure with atrial fibrillation, in: New England Journal of Medicine, 2023, DOI: 10.1056/NEJMoa2306037.