Catheter Ablation for the Cure of Atrial Fibrillation Study - CACAF


The goal of the trial was to evaluate treatment with catheter ablation among patients with paroxysmal or persistent atrial fibrillation who have already failed antiarrhythmic drugs.

Study Design

Study Design:

Patients Screened: 207
Patients Enrolled: 137
Mean Follow Up: One year
Mean Patient Age: Mean age 62 years
Female: 41

Patient Populations:

Paroxysmal or persistent atrial fibrillation in patients intolerant or who failed ≥2 antiarrhythmic drugs and first atrial fibrillation diagnosis at least six months prior to enrollment


Atrial fibrillation as the sole rhythm for the last 12 months, transient atrial fibrillation, atrial fibrillation triggered by another uniform arrhythmia, New York Heart Association class III or IV, unstable angina, recent acute myocardial infarction or cardiac surgery, prior atrial surgery, presence of an implantable device, or transversal left atrial diameter >55 mm

Primary Endpoints:

Total absence of atrial tachyarrhythmia recurrence during 12-month follow-up

Drug/Procedures Used:

Patients were randomized to catheter ablation in addition to antiarrhythmic drugs (n=68) or antiarrhythmic drugs alone (n=69). Patients underwent a single session of catheter ablation.

Principal Findings:

Procedure duration was 193 minutes in the ablation group, with fluoroscopy time of 25 minutes. All patients in the ablation group had right isthmus block and 30% had left isthmus block. Major ablation-related complications occurred in 4.4% of the ablation group. The primary endpoint of atrial arrhythmia-free survival was higher in the ablation group compared with the control group (p<0.001), with 44% of the ablation group and 91% of the control group having at least one atrial fibrillation recurrence.


Among patients with paroxysmal or persistent atrial fibrillation who have already failed antiarrhythmic drugs, use of catheter ablation was associated with a reduction in atrial fibrillation recurrence at one year compared with antiarrhythmic drug therapy alone.

Prior studies of ablation in atrial fibrillation have been primarily nonrandomized or single center, and success has been defined only in terms of symptom relief. The present study is the first multicenter, randomized trial to show a benefit of preventing atrial fibrillation recurrence with a single session of catheter ablation.


Stabile G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study. European Heart Journal 2006;27:216–221.

Presented by Dr. Emanuele Bertaglia at the March 2005 ACC Annual Scientific Session, Orlando, FL.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Nuclear Imaging

Keywords: Fluoroscopy, Atrial Fibrillation, Catheter Ablation, Atrial Flutter

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