CABANA

Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation

Patient / Population Intervention / Exposition Comparaison Critère de jugement

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.

2 204

Schéma

Open-label multicentre RCT

Critère

Composite of death, disabling stroke, serious bleeding, or cardiac arrest

Pertinence

Résultat8.0% 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 et 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.