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March 26, 2019
Comparing treatments for atrial fibrillation
At a Glance
- Compared with medications, a procedure called catheter ablation did not significantly reduce the risk of death or serious complications from atrial fibrillation.
- People who underwent ablation did have a reduced risk of their condition recurring and reported greater quality of life improvements.
- The findings will help inform treatment decisions.
Atrial fibrillation is the most common heart-rhythm disorder among older adults. It causes the heart to beat much faster than normal and prevents the upper and lower chambers of the heart from working together properly. People with atrial fibrillation have an increased risk of stroke and heart failure. The condition can also cause fatigue, dizziness, and other problems that lower quality of life.
Drugs that alter the heart’s pace or rhythm are usually the first treatment for people with atrial fibrillation. But a procedure called catheter ablation has also become common. This uses a flexible tube threaded through a blood vessel to destroy the abnormal heart tissue causing the fibrillation.
It hasn’t been clear whether catheter ablation is more effective than drugs in reducing the risk of death or serious complications of atrial fibrillation. To look at this question, researchers led by Dr. Douglas Packer from the Mayo Clinic enrolled more than 2,000 people into a clinical trial called CABANA. The team randomly assigned patients with atrial fibrillation to either receive drugs or undergo ablation. If drugs failed to control the condition, participants could receive ablation.
The researchers followed participants for an average of 4 years after the start of treatment. They compared rates of death, serious complications, and hospitalizations. They also conducted regular surveys of participants’ quality of life. The study was funded by NIH’s National Heart, Lung, and Blood Institute (NHLBI) and others. Results were published online on March 15, 2019, in JAMA.
About 10% of people assigned to the ablation group ended up not having the procedure. Just under 20% of people in the ablation group required a second procedure due to recurrent symptoms. About a quarter of people initially assigned to receive drugs chose to undergo an ablation at some point during the trial.
No significant difference was seen between the groups in the number of people who died or had a disabling stroke, serious bleeding, or heart attack. However, people in the ablation group had a lower risk of their fibrillation recurring during the study, and a reduced risk of being hospitalized. People in the ablation group also reported higher quality of life and fewer symptoms during the years of follow-up.
Ablation and drugs both have risks and benefits. These results will help patients and their doctors make more informed treatment decisions.
“CABANA, because of its size and duration, provides extraordinary new data regarding the patient’s perspective,” says Dr. Yves Rosenberg, chief of NHLBI’s Atherothrombosis and Coronary Artery Disease Branch.
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- Atrial Fibrillation
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References: Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, Noseworthy PA, Rosenberg YD, Jeffries N, Mitchell LB, Flaker GC, Pokushalov E, Romanov A, Bunch TJ, Noelker G, Ardashev A, Revishvili A, Wilber DJ, Cappato R, Kuck KH, Hindricks G, Davies DW, Kowey PR, Naccarelli GV, Reiffel JA, Piccini JP, Silverstein AP, Al-Khalidi HR, Lee KL; CABANA Investigators. JAMA. 2019 Mar 15. doi: 10.1001/jama.2019.0693. [Epub ahead of print]. PMID: 30874766.
Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Mark DB, Anstrom KJ, Sheng S, Piccini JP, Baloch KN, Monahan KH, Daniels MR, Bahnson TD, Poole JE, Rosenberg Y, Lee KL, Packer DL; CABANA Investigators. JAMA. 2019 Mar 15. doi: 10.1001/jama.2019.0692. [Epub ahead of print]. PMID: 30874716.
Funding: NIH’s National Heart, Lung, and Blood Institute (NHLBI); St. Jude Medical Foundation and Corporation; Biosense Webster; Medtronic; Boston Scientific; and Mayo Clinic.