CABANA

Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation

Paziente / Popolazione Intervento / Esposizione Confronto Esito

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.

2204

Disegno

Open-label multicentre RCT

Esito

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

Rilevanza

Risultato8.0% 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

Discussione e critica

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.