Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long-Standing Persistent Atrial Fibrillation - CASA-AF

Aug 29, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership
Date Presented:
08/29/2020
Date Published:
08/29/2020
Date Updated:
08/29/2020
Original Posted Date:
08/29/2020
References

Contribution To Literature:

The CASA-AF trial showed that a surgical ablation of atrial fibrillation was not superior to catheter ablation at maintaining sinus rhythm. 

Description:

The goal of the trial was to evaluate catheter ablation compared with thoracoscopic surgical ablation among patients with long-standing persistent atrial fibrillation.


Study Design

  • Randomized
  • Parallel

Eligible patients were randomized to thoracoscopic surgical ablation (n = 60) versus catheter ablation (n = 60).

  • Total number of enrollees: 120
  • Duration of follow-up: 12 months
  • Mean patient age: 62 years
  • Percentage female: 26%
  • Percentage with diabetes: 7.5

Inclusion criteria:

  • Symptomatic long-standing persistent atrial fibrillation
  • Left ventricular ejection fraction ≥40%
  • Suitable for either treatment option

Exclusion criteria:

  • Significant valvular heart disease
  • Previous cardiothoracic surgery

Principal Findings:

The primary outcome, freedom from atrial fibrillation/tachycardia at 12 months, occurred in 26% of the surgical ablation group compared with 28% of the catheter ablation group (p = 0.84).

Secondary outcomes:

  • Reduction in atrial fibrillation/tachycardia ≥75% at 12 months: 67% of the surgical ablation group compared with 77% of the catheter ablation group (p = 0.3)
  • Procedure-related serious adverse events within 30 days: 15% of the surgical ablation group compared with 10% of the catheter ablation group (p = 0.46)
  • Patient-reported symptoms and quality of life measure were significantly improved for catheter ablation compared with surgical ablation (p = 0.02)

Interpretation:

Among patients with long-standing persistent atrial fibrillation, surgical ablation of atrial fibrillation was not superior to catheter ablation. Freedom from atrial fibrillation/tachycardia and reduction in atrial fibrillation/tachycardia ≥75% was similar between treatment groups. Procedure-related serious adverse events were also similar between treatment groups. Improvement in symptoms and quality of life favored catheter ablation. Effective management of long-standing persistent atrial fibrillation remains challenging; however, based on this trial, catheter ablation may be considered first-line therapy for symptomatic long-standing persistent atrial fibrillation, refractory to drug therapy.

References:

Haldar S, Khan HR, Boyalla V, et al. Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial. Eur Heart J 2020;Aug 29:[Epub ahead of print].

Presented by Dr. Shouvik Haldar at the European Society of Cardiology Virtual Congress, August 29, 2020.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: ESC Congress, ESC20, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Surgical Procedures, Catheter Ablation, Quality of Life, Tachycardia, Tachycardia, Supraventricular, Ventricular Function, Left


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