
The CASTLE-VT trial aims to assess whether prophylactic catheter ablation of arrhythmogenic ventricular scar tissue can reduce mortality, left ventricular assist device (LVAD) implantation, and urgent heart transplantation (HTx) in patients with end-stage heart failure (HF) due to ischaemic cardiomyopathy (ICM). This randomized trial involves 160 patients referred for HTx evaluation, who will undergo substrate-based ablation targeting myocardial scar tissue to prevent life-threatening arrhythmias. Primary outcomes include all-cause mortality and worsening HF requiring prioritized HTx or LVAD, while secondary outcomes include cardiovascular mortality, implantable cardioverter-defibrillator (ICD) therapy incidence, quality of life, hospitalizations, and exercise tolerance.
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