Atrial Fibrillation Ablation in Practice

Mar 26, 2019
Font Size
A
A
A
Authors:
Noseworthy PA, Gersh BJ, Kent DM, et al.
Citation:
Atrial Fibrillation Ablation in Practice: Assessing CABANA Generalizability. Eur Heart J 2019;Mar 15:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Is the improvement in outcomes reported among patients with atrial fibrillation (AF) in the CABANA trial treated by catheter ablation compared to medical therapy also observed in clinical practice?

Methods:

This was an observational study that identified 183,760 patients in an administrative database who had AF treated with ablation (n = 12,032) or medications alone (n = 171,728). Propensity score weighting based on 90 variables was used to match patients in the two groups. The primary endpoint was a composite of all-cause mortality, stroke, major bleeding, and cardiac arrest, as in the CABANA (Catheter Ablation vs. Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial.

Results:

At a median duration of follow-up of 1.8 years, ablation was associated with a 25% relative reduction in the primary endpoint. A relative reduction of 30% in the composite endpoint was observed in the 74% of patients who would have been eligible for enrollment in the CABANA trial, whereas a significant reduction was not observed among the patients who would not have been trial-eligible.

Conclusions:

The authors concluded that the improvement in the composite outcome endpoint observed in the CABANA trial is also observed in clinical practice.

Perspective:

The complete results of the CABANA trial have not yet been published. However, the investigators have reported a significant improvement in the composite endpoint in the ablation arm compared to the medical therapy arm, albeit only when an on-treatment analysis is used, not the more conventional intention-to-treat analysis usually used in randomized clinical trials (RCTs). For a variety of possible reasons, the results of RCTs cannot always be reproduced in routine clinical practice. This study, although observational in nature and not randomized, provides evidence that the on-treatment results of the CABANA trial are reproducible outside of an RCT.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Heart Arrest, Hemorrhage, Secondary Prevention, Stroke, Vascular Diseases


< Back to Listings