CABANA
Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation
Patient / Population Intervention / Exposure Comparison Outcome
In 2,204 patients with symptomatic atrial fibrillation, catheter ablation did not significantly reduce death, disabling stroke, serious bleeding, or cardiac arrest compared with antiarrhythmic drug therapy.
N
2,204
Design
Open-label multicentre RCT
Endpoint
Composite of death, disabling stroke, serious bleeding, or cardiac arrest
Relevance
2
Result8.0% vs 9.2% (HR 0.86, 95% CI 0.65-1.15; P=0.30); neutral by intention-to-treat. Per-protocol and as-treated analyses favoured ablation.
Packer DL, et al. JAMA. 2019;321(13):1261-1274. 10.1001/jama.2019.0693
Discussion & critique
Substantial crossover between arms diluted the intention-to-treat comparison. Although the primary endpoint was neutral, ablation improved quality of life and became reasonable first-line rhythm control for symptomatic AF.