Trial reportHeart rhythm2020
Generalizability of the CASTLE-AF trial: Catheter ablation for patients with atrial fibrillation and heart failure in routine practice.
Trial report in Heart rhythm, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 71 citations in OpenAlex.
- Comparison of the Efficacy and Safety Endpoints of Five Therapies for Atrial Fibrillation: A Network Meta-Analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Generalizability of the EAST-AFNET 4 Trial: Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation.Journal of the American Heart Association · 2022Trial
- Which Patient Benefits from Guideline-directed Medical Therapy for Heart Failure and Rate Control versus Rhythm Control in Patients with Congestive Heart Failure and Atrial Fibrillation and What are Those Therapies?Arrhythmia & electrophysiology review · 2026Review
- Brazilian Atrial Fibrillation Guidelines - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020.Journal of the American Heart Association · 2024Article
- Atrial fibrillation: comorbidities, lifestyle, and patient factors.The Lancet regional health. Europe · 2024Review
- Antiarrhythmic Treatment in Heart Failure.Current heart failure reports · 2024Review
- Approval, Evidence, and "Off-Label" Device Utilization: The Patent Foramen Ovale Closure Story.Circulation. Cardiovascular quality and outcomes · 2024Article
- Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Review
- Outcomes of Early Rhythm Control Therapy in Patients With Atrial Fibrillation and a High Comorbidity Burden in Large Real-World Cohorts.Circulation. Arrhythmia and electrophysiology · 2023Article
- Atrial fibrillation in heart failure: drugs or ablation?European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- Prognostic benefit of catheter ablation of atrial fibrillation in heart failure: An updated meta-analysis of randomized controlled trials.Journal of arrhythmia · 2023Article
- Patient selection, peri-procedural management, and ablation techniques for catheter ablation of atrial fibrillation: an EHRA survey.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Managing arrhythmia in cardiac resynchronisation therapy.Frontiers in cardiovascular medicine · 2023Review
- Opportunities and challenges in heart rhythm research: Rationale and development of an electrophysiology collaboratory.Heart rhythm · 2022Review
- Feasibility and safety of same-day discharge and shortened bedrest after atrial fibrillation ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2022Article
- Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives.Biomedicines · 2022Review
- Update on management of atrial fibrillation in heart failure: a focus on ablation.Heart (British Cardiac Society) · 2022Review
- Is It Safe (and When) to Stop Oral Anticoagulation After Ablation for Atrial fibrillation? (Do We Have Enough Evidence to Solve the Dilemma?).Cardiovascular drugs and therapy · 2021Article
- Atrial fibrillation and heart failure: A contemporary review of current management approaches.Heart rhythm O2 · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundIn the Catheter Ablation for Atrial Fibrillation with Heart Failure (CASTLE-AF) trial, catheter ablation reduced the risk of death and heart failure (HF) hospitalization in patients with atrial fibrillation and HF by 40%.
objectivesThe study aimed to assess the generalizability of CASTLE-AF to routine clinical practice.
methodsUsing a large US administrative database, we identified 289,831 patients with atrial fibrillation and HF treated with ablation (n = 7465) or medical therapy alone (n = 282,366) from January 1, 2008, through August 31, 2018. Patients were divided into 3 groups on the basis of trial eligibility: (1) eligible for CASTLE-AF, (2) failing to meet the inclusion criteria, and (3) meeting at least 1 of the exclusion criteria. Propensity score overlap weighting was used to balance ablated and drug-treated patients on 90 baseline characteristics. Cox proportional hazards regression was used to compare ablation with medical therapy for the primary outcome of a composite end point of all-cause mortality and HF hospitalization.
resultsOnly 7.8% of patients would have been eligible for the trial; 91.0% failed to meet the trial inclusion criteria; and 15.5% met the exclusion criteria. Ablation was associated with a lower risk of the primary outcome in the overall cohort (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.76-0.87; P < .001), in the trial-eligible cohort (HR 0.82; 95% CI 0.70-0.96; P = .01), and in patients who failed to meet inclusion criteria (HR 0.79; 95% CI 0.73-0.86; P < .001) but not in patients who met the exclusion criteria (HR 0.97; 95% CI 0.81-1.17). The relative risk reduction was consistent regardless of whether patients had HF with reduced left ventricular ejection fraction.
conclusionThe benefit associated with ablation appears to be more modest in practice than that reported in the CASTLE-AF trial.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.