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Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2020 Jun 30; Vol. 75 (25), pp. 3105-3118. - Publication Year :
- 2020
-
Abstract
- 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.<br />Objectives: The purpose of this study was to assess recurrence of AF in the CABANA trial.<br />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.<br />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.<br />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. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508).<br /> (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Female
Humans
Male
Outcome and Process Assessment, Health Care
Recurrence
Stroke etiology
Stroke prevention & control
Time
Anti-Arrhythmia Agents administration & dosage
Anti-Arrhythmia Agents adverse effects
Atrial Fibrillation diagnosis
Atrial Fibrillation drug therapy
Atrial Fibrillation physiopathology
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Catheter Ablation methods
Catheter Ablation statistics & numerical data
Electrocardiography, Ambulatory methods
Electrocardiography, Ambulatory statistics & numerical data
Intention to Treat Analysis statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 75
- Issue :
- 25
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 32586583
- Full Text :
- https://doi.org/10.1016/j.jacc.2020.04.065