Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation

To the Editor: In the CASTLE-HTx (Catheter Ablation for Atrial Fibrillation in Patients with End-Stage Heart Failure and Eligibility for Heart Transplantation) trial reported by Sohns et al. (Oct. 12 issue),(1) patients with end-stage heart failure and atrial fibrillation were randomly assigned to receive either catheter ablation and medical therapy or medical therapy alone. Previous studies have shown the benefit of ablation for atrial fibrillation in patients with less advanced heart failure.(2) Patients who were candidates for urgent heart transplantation and those who were at high risk for death within 12 months were excluded from the trial. Most patients in . . .