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ACC: Catheter Ablation Does Not Cut Mortality, Stroke in A-Fib

WEDNESDAY, March 20, 2019 -- For patients with atrial fibrillation (AF), catheter ablation does not significantly reduce the risk for death, disabling stroke, serious bleeding, or cardiac arrest, but it does improve quality of life versus medical therapy, according to two studies published online March 15 in the Journal of the American Medical Association. The research was published to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.

Douglas L. Packer, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a multicenter trial involving 2,204 symptomatic patients with AF. Patients were randomly assigned to either the catheter ablation group (1,108 patients) or a drug therapy group (1,096 patients). The researchers found that in the intention-to-treat analysis, the primary end point (composite of death, disabling stroke, serious bleeding, or cardiac arrest) occurred in 8.0 and 9.2 percent of patients in the ablation and drug therapy groups, respectively (hazard ratio, 0.86; 95 percent confidence interval, 0.65 to 1.15; P = 0.30), during a median follow-up of 48.5 months.

Daniel B. Mark, M.D., M.P.H., from Duke University in Durham, North Carolina, and colleagues examined prespecified coprimary quality-of-life end points at 12 months in the same group of patients. The researchers found that at 12 months, the mean Atrial Fibrillation Effect on Quality of Life summary score was more favorable in the catheter ablation group versus the drug therapy group (86.4 versus 80.9 points; adjusted difference, 5.3 points; 95 percent confidence interval, 3.7 to 6.9; P < 0.001).

"Shared decision making between the cardiologist and the patient is the best answer and is critical in determining treatment," write the authors of an accompanying editorial. "The CABANA trial provides a wealth of additional data regarding the comparative benefits and risks of catheter ablation versus drug therapy to inform this process."

Several authors from both studies and the editorial disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text - Packer
Abstract/Full Text - Mark
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Posted: March 2019

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