VIDEO: CASTLE-AF suggests atrial fibrillation burden better predicts outcomes

This new analysis of data from the CASTLE-AF trial is exciting. It shows that, if we reduce the atrial fibrillation burden when we perform catheter ablation of atrial fibrillation in patients with heart failure, patients do better.

Until now, cardiac electrophysiologists who perform atrial fibrillation (AF) ablation have been too hard on themselves by counting as a failure every patient who develops an AF recurrence that lasts for 30 seconds or more. We know that patients who have a substantial drop in their AF burden after catheter ablation report feeling better even if they continue to have some AF events. When their AF burden drops substantially, patients are better able to work and perform activities of daily life. Many options, including noninvasive devices, are now available to monitor patients’ postablation change in AF burden.

We currently tell patients the success rates of catheter ablation on AF based on recurrence rates. Maybe we need to change our definition of success to a cut in AF burden. Based on these new findings, patients don’t need to be perfect after ablation, with absolutely no recurrences. I have patients who are very happy with their outcome after ablation who still have episodes. The success rate of catheter ablation for treating AF may be much better than we have thought.

Andrea M. Russo, MD , is professor and director of the electrophysiology and arrhythmia service at Cooper University Health Care in Camden, N.J. She made these comments during a press conference and in a video interview. She had no relevant disclosures.