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Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial

Journal of the American College of Cardiology, 2020-06, Vol.75 (25), p.3105-3118 [Peer Reviewed Journal]

2020 American College of Cardiology Foundation ;Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2020.04.065 ;PMID: 32586583

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Title:
Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial
Author: Poole, Jeanne E. ; Bahnson, Tristram D. ; Monahan, Kristi H. ; Johnson, George ; Rostami, Hoss ; Silverstein, Adam P. ; Al-Khalidi, Hussein R. ; Rosenberg, Yves ; Mark, Daniel B. ; Lee, Kerry L. ; Packer, Douglas L. ; Poole, Jeanne E. ; Akoum, Nazem ; Aoukar, Pierre ; Birgersdotter-Green, Ulrika ; Blatt, Joseph ; Cha, Yong Mei ; Chung, Mina ; Gleva, Marye ; Glotzer, Taya ; Henrickson, Charles ; Kron, Jack ; Kuriachan, Vikas ; Mulpuru, Siva ; Noseworthy, Peter ; Patton, Kris ; Prutkin, Jordan ; Ranjan, Ravi ; Rho, Robert ; Russo, Andrea ; Stecker, Eric ; Tzou, Wendy ; Serdoz, Laura Vitali ; Wilson, Mauri
Subjects: Aged ; Anti-Arrhythmia Agents - administration & dosage ; Anti-Arrhythmia Agents - adverse effects ; antiarrhythmic drug therapy ; atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; catheter ablation ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Catheter Ablation - statistics & numerical data ; Electrocardiography, Ambulatory - methods ; Electrocardiography, Ambulatory - statistics & numerical data ; Female ; Humans ; Intention to Treat Analysis - statistics & numerical data ; long-standing persistent atrial fibrillation ; Male ; Outcome and Process Assessment, Health Care ; paroxysmal atrial fibrillation ; persistent atrial fibrillation ; pulmonary vein isolation ; Recurrence ; Stroke - etiology ; Stroke - prevention & control ; Time
Is Part Of: Journal of the American College of Cardiology, 2020-06, Vol.75 (25), p.3105-3118
Description: 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. The purpose of this study was to assess recurrence of AF in the CABANA trial. 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. 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. 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) [Display omitted]
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2020.04.065
PMID: 32586583
Source: Geneva Foundation Free Medical Journals at publisher websites
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Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial

2020 American College of Cardiology Foundation ;Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2020.04.065 ;PMID: 32586583

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