Catheter ablation significantly reduced the first recurrence of any symptomatic or asymptomatic atrial fibrillation compared with antiarrhythmic drug therapy (HR 0.52; 95% CI 0.45-0.60; p<0.001).
RCT (n=1,240)
Does catheter ablation reduce recurrence of atrial fibrillation compared with antiarrhythmic drug therapy in patients with atrial fibrillation?
Catheter ablation significantly reduces the recurrence and burden of atrial fibrillation compared to antiarrhythmic drug therapy over 5 years of follow-up.
Effect estimate: HR 0.52 (95% CI 0.45-0.60)
p-value: p=<0.001
CABANA randomized 2204 patients with atrial fibrillation (AF) to catheter ablation or drug therapy. Analysis by intention-to-treat (ITT), showed a non-significant 14% relative reduction in the primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest. To assess recurrence of atrial fibrillation (AF) in The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) We prospectively studied CABANA patients using a proprietary ECG recording monitor for symptom-activated and 24-hour AF auto detection. The AF recurrence endpoint was any post 90-day blanking atrial tachyarrhythmias lasting 30 seconds or longer. Ninety-six-hour Holter monitoring obtained biannually was used to assess AF burden. Patients using the CABANA monitors and provided 90-day post-blanking recordings qualified for this analysis (1240, 56% of CABANA population). Treatment comparisons were performed using a modified- ITT approach. Median age of the 1240 patients was 68 years, 34.4% women, and AF was paroxysmal in 43.0%. Over 60 months of follow-up, first recurrence of any symptomatic or asymptomatic AF (hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.45, 0.60, P <0.001) or, first symptomatic-only AF (HR 0.49, 95% CI 0.39, 0.61, P <0.001) were both significantly reduced in the catheter ablation group. Baseline Holter AF burden in both treatment groups was 48%. At 12 months, AF burden in ablation patients averaged 6.3%, and in drug therapy patients, 14.4%. AF burden was significantly less in catheter ablation compared with drug therapy patients across the 5-year follow-up ( P <0.001). These findings were not sensitive to the baseline pattern of AF. Catheter ablation was effective in reducing recurrence of any AF by 48% and symptomatic AF by 51% as compared to drug therapy over 5 years of follow-up. Furthermore, AF burden was also significantly reduced in catheter ablation patients, regardless of their baseline AF type. Keywords: Atrial Fibrillation, Paroxysmal Atrial Fibrillation, Persistent Atrial Fibrillation, Long-Standing Persistent Atrial Fibrillation, Anti-Arrhythmic Drug Therapy, Catheter Ablation, Pulmonary Vein Isolation
“These data support the finding of smaller trials that catheter ablation is superior to drug therapy to prevent recurrent AF. CABANA was the largest trial conducted comparing a strategy of ablation to drug therapy, and across a broad group of patients with cardiovascular comorbidities. Our findings support catheter ablation as an important strategy which can be offered to patients with AF.”
Poole et al. (Mon,) conducted a rct in Atrial fibrillation (n=1,240). Catheter ablation vs. Antiarrhythmic drug therapy was evaluated on First recurrence of any symptomatic or asymptomatic atrial fibrillation (post-90-day blanking atrial tachyarrhythmias lasting ≥30 s) (HR 0.52, 95% CI 0.45-0.60, p=<0.001). Catheter ablation significantly reduced the first recurrence of any symptomatic or asymptomatic atrial fibrillation compared with antiarrhythmic drug therapy (HR 0.52; 95% CI 0.45-0.60; p<0.001).
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