CASTLE-AF Trial — EECC MCQ
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Correct answer: E — Catheter ablation in patients with AF and HFrEF significantly reduced a composite of all-cause mortality and HF hospitalisation compared with medical rate/rhythm control
The CASTLE-AF trial (2018) demonstrated that catheter ablation (PVI ± additional lesions) in patients with symptomatic AF and HFrEF (LVEF ≤35%, ICD/CRT-D implanted) significantly reduced the composite of all-cause death and HF hospitalisation by 38%, with significant reductions in both components individually, compared with conventional medical therapy (rate or rhythm control). This was corroborated by the RAFT-AF trial (2023). The 2024 ESC AF Guidelines recommend catheter ablation as a Class IIa recommendation in AF patients with HFrEF to improve LVEF and outcomes. The benefit may be mediated by restoration of sinus rhythm, rate regularisation, and avoidance of antiarrhythmic drug toxicity.
Reference: ESC (2024): AF Guidelines; CASTLE-AF Trial