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. 2019 Apr 21;40(16):1257-1264.
doi: 10.1093/eurheartj/ehz085.

Atrial fibrillation ablation in practice: assessing CABANA generalizability

Peter A Noseworthy  1   2 , Bernard J Gersh  2 , David M Kent  3   4 , Jonathan P Piccini  5 , Douglas L Packer  2 , Nilay D Shah  1   6   7 , Xiaoxi Yao  1   6
Affiliations

Atrial fibrillation ablation in practice: assessing CABANA generalizability

Peter A Noseworthy et al. Eur Heart J. .

Abstract

Aims: The Catheter Ablation vs. Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial aimed to assess the impact of ablation on morbidity and mortality. This observational study was conducted in parallel to CABANA to assess trial generalizability.

Methods and results: Using a large US administrative database, we identified 183 760 patients with atrial fibrillation (AF) treated with ablation or medical therapy (antiarrhythmic or rate control drugs) between 1 August 2009 and 30 April 2016 (CABANA enrolment period). Propensity score weighting was used to balance patients treated with ablation (N = 12 032) or medical therapy alone (N = 171 728) on 90 dimensions. Ablation was associated with a reduction in the composite endpoint of all-cause mortality, stroke, major bleeding, and cardiac arrest [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.70-0.81; P < 0.001]. The majority of patients (73.8%) were potentially trial eligible; among whom the risk reduction associated with ablation was greatest (HR 0.70, 95% CI 0.63-0.77; P < 0.001). Among the 3.8% of patients who failed to meet the inclusion criterion, i.e. patients under 65 years without stroke risk factors, the event rates were low and there was no significant relationship with ablation (HR 0.67, 95% CI 0.29-1.56; P = 0.35). Among the 22.4% patients who met at least one of the trial exclusion criteria, there was a lesser but statistically significant reduction associated with ablation (HR 0.85, 95% CI 0.75-0.95; P = 0.01).

Conclusion: In routine clinical care, ablation was associated with a reduction in the primary CABANA composite endpoint of all-cause mortality, stroke, major bleeding, and cardiac arrest, particularly in patients who were eligible for the trial.

Keywords: Ablation; Atrial fibrillation; Mortality; Stroke.

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Figures

Figure 1
Figure 1
Primary endpoint (composite of mortality, stroke, major bleeding, or cardiac arrest) in ablated or drug-treated patients, stratified by CABANA trial eligibility criteria. The cumulative incidence in the overall cohort (A), in patients who would be potentially eligible for CABANA (B), in patients who failed to meet the inclusion criterion (C), and in patients who met at least one of the CABANA exclusion criteria (D). The drug-treated cohort was the reference group in the Cox proportional hazards regression analyses. All the curves and numbers were calculated using propensity score weighting.
Take home figure
Take home figure
Hazard ratio for primary outcome stratified by potential trial-eligibility in the overall population (N = 183 760).
None
See this image and copyright information in PMC

Comment in

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