CABANA: Catheter Ablation for Afib Gets a QoL Boost

Atrial fibrillation (Afib) patients who had catheter ablation done in the CABANA trial tended to score higher on quality-of-life questionnaires later on, investigators reported.

Self-reported outcomes on several scales at 12 months favored those who were randomized to catheter ablation instead of standard medical therapy, according to a group led by Daniel Mark, MD, MPH, of the Duke Clinical Research Institute in Durham, North Carolina:

  • Atrial Fibrillation Effect on Quality of Life summary score: 86.4 vs 80.9 points (P<0.001)
  • Mayo AF-Specific Symptom Inventory frequency score (6.4 vs 8.1 points, P<0.001) and severity score (5.0 vs 6.5 points, P<0.001)

Patients with the worst quality-of-life assessments at baseline reported the greatest improvement after catheter ablation.

For the 2,204 symptomatic patients in CABANA, catheter ablation "led to clinically important and significant improvements in quality of life at 12 months," the authors concluded. Their findings were published online in JAMA with top-line results previously reported at the European Society of Cardiology meeting last year.

CABANA had missed its primary endpoint, researchers reported last year, as the intention-to-treat analysis of the trial showed no benefit to catheter ablation in terms of hard outcomes such as combined death, disabling stroke, serious bleeding, or cardiac arrest; nor all-cause mortality alone.

In a per-protocol analysis accounting for cross-overs, however, the procedure did appear to improve the primary composite endpoint (7.0% vs 10.9%, P=0.006) and all-cause mortality (4.4% vs 7.5%, P=0.005).

A similar phenomenon was observed in the present quality-of-life study, as treatment benefits with catheter ablation appeared to hit a ceiling at 12 months and decline slowly thereafter; this late attenuation was no longer present in a per-protocol analysis, according to Mark and colleagues.

Study participants went into CABANA at a median age of 68 and comprised a cohort with 63% being men. Paroxysmal Afib accounted for 43% of cases (the rest getting treated for persistent Afib).

Follow-up lasted a median of 48.5 months.

One limitation of the trial was its open-label design: quality-of-life data were collected via phone interviews in which North American patients got blinded interviews but others everywhere else were interviewed by local site coordinators who had access to treatment assignments, Mark's group said.

CABANA was supported by grants from the National Heart, Lung, and Blood Institute; the St. Jude Foundation and Corporation; Biosense Webster; Medtronic; Boston Scientific; and the Mayo Clinic.

Mark reported receiving grants from the NIH and the Mayo Clinic during the conduct of the study; as well as grants from Merck, Oxygen Therapeutics, Bristol-Myers Squibb, AstraZeneca, the University of Calgary, Eli Lilly & Company, AGA Medical, St. Jude Medical, and Tufts University and personal fees from CeleCor and Novo Nordisk.


9 Key Findings of the cabana Study

When drugs don't work or produce unacceptable side effects, alternative treatments include surgery or catheter ablation. Which raises an green Space Good for Your Child’s Mental Health interesting questionare atrial fibrillation patients with symptoms somehow healthier than atrial fibrillation patients without symptoms? Minorities Fared Better with Ablation This is a finding from the cabana Study that Im not sure what it means. But this treatment sort of suspends afib patients in a waiting and watching middle ground, stuck in limbo with a diminished quality of life and an increased risk of stroke. Treatment for...

On the other hand, the primary end point of death, strokes, bleeding, and cardiac arrests of this study was dramatically lowered with ablation. As our hospital was the top enrolling site in the US, I can tell two STIs Confer Similar Risks for Reproductive Problems you that I personally saw more drug complications than ablation complications in this study. Some of those who have afib may have no outward symptoms, but are still at risk of serious and long-term damage to the heart. If you cant reverse atrial fibrillation with an optimized lifestyle then it may be a reasonable option. "I would lose my breath and could feel my heart racing and fluttering she said. For those in whom drugs dont work or cause side effects, then ablation is definitely a logical choice.