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Atrial fibrillation (AF) frequently accompanies heart failure, particularly with reduced ejection fraction (HFrEF). A rhythm control strategy theoretically offers the potential for clinical benefit, but antiarrhythmic agents have not been proven to improve outcomes. Catheter ablation of AF might provide clinical benefit without the toxicities of antiarrhythmic agents but might involve procedural risks. In the randomized, controlled CASTLE-AF study (NEJM JW Cardiol Apr 2018 and N Engl J Med 2018; 378:417), patients receiving ablation had reductions in mortality and admissions for heart failure. The current researchers conducted a meta-analysis of six randomized, controlled trials, including CASTLE-AF, of AF ablation in patients with HFrEF.
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