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Catheter ablation marginally better than usual care for symptomatic atrial fibrillation (CABANA)
Question clinique
Is catheter ablation more effective than standard medical therapy for restoring sinus rhythm in adults with atrial fibrillation?
L’Essentiel
This study found no significant benefit to immediate catheter ablation vs standard medical therapy in adults with symptomatic atrial fibrillation (AF) in reducing the composite outcome of death, stroke, serious bleeding, or cardiac arrest. Of the patients initially assigned to standard drug therapy, almost 30% eventually required catheter ablation because of persistent symptoms. A second publication in the same journal with results from the same study reported a minimal clinically significant improvement in quality of life with catheter ablation compared with drug therapy at 12 months. Overall, it appears that drug therapy alone is successful for treating approximately 70% of adults with symptomatic AF. There may, however, be an improvement in quality of life from immediate ablation. 1b
Référence
Plan de l'etude: Randomized controlled trial (single-blinded)
Financement: Industry + govt
Cadre: Outpatient (any)
Sommaire
The Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) randomized clinical trial was designed to test whether ablative therapy is more effective than standard medical therapy for AF. These investigators identified 2204 adults, either 65 years and older or younger than 65 years with at least 1 risk factor for stroke (eg, hypertension, heart failure, previous stroke, or diabetes) with 2 or more episodes of paroxysmal AF or 1 episode of persistent AF in the prior 6 months. Eligible patients randomly received (concealed allocation assignment) either catheter ablation or drug therapy in addition to standard anticoagulation therapy. Individuals masked to treatment group assignment assessed outcomes. Complete follow-up occurred for 89.3% of patients for a median duration of 48.5 months. Of the patients assigned to catheter ablation, 1006 (90.8%) underwent the procedure. Of the patients assigned to drug therapy, 301 (27.5%) eventually underwent catheter ablation because of persistent symptomatic AF. Using intention-to-treat analysis, there were no significant group differences in the primary composite end point of death, stroke, serious bleeding, or cardiac arrest.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC