1. Potera, Carol


Death, stroke, and cardiac arrest outcomes are comparable to drug therapy.


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Catheter ablation improved quality of life more than standard drug therapy in patients with atrial fibrillation, according to results of a large multicenter randomized trial. At the study's start, quality of life scores were similar for patients in the catheter ablation and drug therapy groups. After 12 months, the catheter ablation group had a quality of life score of 86.4, compared with 80.9 in the drug therapy group; after five years, the scores were 86.2 and 83.3 in the catheter ablation group and drug group, respectively.


These results come from the landmark Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, the largest clinical trial to compare treatments for atrial fibrillation, which affects more than 30 million people worldwide and raises the risk of stroke and heart failure. The CABANA trial randomized 2,204 patients from 10 countries with new-onset or undertreated atrial fibrillation to either catheter ablation or drug therapy.


At 12 months, 14% more patients in the catheter ablation group had complete or near-complete relief of atrial fibrillation symptoms, as well as very low rates of complications, such as tamponade, hematomas, and pseudoaneurysms. But catheter ablation did not significantly reduce death, disabling strokes, serious bleeding, or cardiac arrest, compared with drug treatment. Patients who had the greatest impairment in quality of life at the beginning of the study showed greater incremental improvement with catheter ablation compared with drug therapy.


According to a related commentary, the new findings provide "essential information to optimize the care of patients with [atrial fibrillation] in a very patient-centric way."-Carol Potera




Packer DL, et al JAMA 2019 Mar 15 [Epub ahead of print]; Mark DB, et al. JAMA 2019 Mar 15 [Epub ahead of print]; Albert CM, Bhatt DL. JAMA 2019 Mar 15 [Epub ahead of print].