TY - JOUR
T1 - Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial
AU - CABANA Investigators and ECG Rhythm Core Lab
AU - Poole, Jeanne E.
AU - Bahnson, Tristram D.
AU - Monahan, Kristi H.
AU - Johnson, George
AU - Rostami, Hoss
AU - Silverstein, Adam P.
AU - Al-Khalidi, Hussein R.
AU - Rosenberg, Yves
AU - Mark, Daniel B.
AU - Lee, Kerry L.
AU - Packer, Douglas L.
AU - Akoum, Nazem
AU - Aoukar, Pierre
AU - Birgersdotter-Green, Ulrika
AU - Blatt, Joseph
AU - Cha, Yong Mei
AU - Chung, Mina
AU - Gleva, Marye
AU - Glotzer, Taya
AU - Henrickson, Charles
AU - Kron, Jack
AU - Kuriachan, Vikas
AU - Mulpuru, Siva
AU - Noseworthy, Peter
AU - Patton, Kris
AU - Prutkin, Jordan
AU - Ranjan, Ravi
AU - Rho, Robert
AU - Russo, Andrea
AU - Stecker, Eric
AU - Tzou, Wendy
AU - Serdoz, Laura Vitali
AU - Wilson, Mauri
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/6/30
Y1 - 2020/6/30
N2 - Background: The CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial randomized 2,204 patients with atrial fibrillation (AF) to catheter ablation or drug therapy. Analysis by intention-to-treat showed a nonsignificant 14% relative reduction in the primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest. Objectives: The purpose of this study was to assess recurrence of AF in the CABANA trial. Methods: The authors prospectively studied CABANA patients using a proprietary electrocardiogram recording monitor for symptom-activated and 24-h AF auto detection. The AF recurrence endpoint was any post–90-day blanking atrial tachyarrhythmias lasting 30 s or longer. Biannual 96-h Holter monitoring was used to assess AF burden. Patients who used the CABANA monitors and provided 90-day post-blanking recordings qualified for this analysis (n = 1,240; 56% of CABANA population). Treatment comparisons were performed using a modified intention-to-treat approach. Results: Median age of the 1,240 patients was 68 years, 34.4% were women, and AF was paroxysmal in 43.0%. Over 60 months of follow-up, first recurrence of any symptomatic or asymptomatic AF (hazard ratio: 0.52; 95% confidence interval: 0.45 to 0.60; p < 0.001) or first symptomatic-only AF (hazard ratio: 0.49; 95% confidence interval: 0.39 to 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. Conclusions: Catheter ablation was effective in reducing recurrence of any AF by 48% and symptomatic AF by 51% compared with 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.
AB - Background: The CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial randomized 2,204 patients with atrial fibrillation (AF) to catheter ablation or drug therapy. Analysis by intention-to-treat showed a nonsignificant 14% relative reduction in the primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest. Objectives: The purpose of this study was to assess recurrence of AF in the CABANA trial. Methods: The authors prospectively studied CABANA patients using a proprietary electrocardiogram recording monitor for symptom-activated and 24-h AF auto detection. The AF recurrence endpoint was any post–90-day blanking atrial tachyarrhythmias lasting 30 s or longer. Biannual 96-h Holter monitoring was used to assess AF burden. Patients who used the CABANA monitors and provided 90-day post-blanking recordings qualified for this analysis (n = 1,240; 56% of CABANA population). Treatment comparisons were performed using a modified intention-to-treat approach. Results: Median age of the 1,240 patients was 68 years, 34.4% were women, and AF was paroxysmal in 43.0%. Over 60 months of follow-up, first recurrence of any symptomatic or asymptomatic AF (hazard ratio: 0.52; 95% confidence interval: 0.45 to 0.60; p < 0.001) or first symptomatic-only AF (hazard ratio: 0.49; 95% confidence interval: 0.39 to 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. Conclusions: Catheter ablation was effective in reducing recurrence of any AF by 48% and symptomatic AF by 51% compared with 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.
KW - antiarrhythmic drug therapy
KW - atrial fibrillation
KW - catheter ablation
KW - long-standing persistent atrial fibrillation
KW - paroxysmal atrial fibrillation
KW - persistent atrial fibrillation
KW - pulmonary vein isolation
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U2 - 10.1016/j.jacc.2020.04.065
DO - 10.1016/j.jacc.2020.04.065
M3 - Article
C2 - 32586583
AN - SCOPUS:85086378933
SN - 0735-1097
VL - 75
SP - 3105
EP - 3118
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -