Impact of disease progression avoidance by catheter ablation on clinical outcomes in atrial fibrillation: Insights from the CABANA trial.

BACKGROUND

Delaying disease progression by catheter ablation has been recognized in patients with paroxysmal atrial fibrillation (AF); however, its direct association with clinical outcome improvement remains unclear.

OBJECTIVE

This study aimed to evaluate the effect of catheter ablation on reducing AF progression and associations with outcomes.

METHODS

The Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial compared the efficacy of catheter ablation with drug therapy in 2204 patients with AF. CABANA participants with paroxysmal AF at enrollment were included in this subanalysis. The primary endpoint was time to the first documented episode of persistent AF after a 90-day blanking period.

RESULTS

Among 2204 CABANA total population, 854 patients had paroxysmal AF at baseline, with 413 patients assigned to catheter ablation and 441 to drug therapy. During a median follow-up of 49.7 months, AF progression occurred in 66 patients (16.0%) of the ablation group compared with 122 patients (27.7%) of the drug treatment group (adjusted hazard ratio 0.52; 95% confidence interval 0.38-0.70). Among participants without AF progression, catheter ablation significantly reduced the incidence of death or cardiovascular hospitalization, whereas no significant effect was observed among those who developed AF progression. The mediation analysis identified that AF progression avoidance explained 23.3% of the treatment effect of catheter ablation compared with drug therapy in reducing death or cardiovascular hospitalization events.

CONCLUSION

In this post hoc analysis of the CABANA trial, catheter ablation significantly reduced the occurrence of AF progression. The large randomized trial data provide proof of concept evidence that progression avoidance by ablation may be transformed into clinical outcome improvements.