Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial

Poole, Jeanne E.; Bahnson, Tristram D.; Monahan, Kristi H.; Johnson, George; Rostami, Hoss; Silverstein, Allen; Al‐Khalidi, Hussein R.; Rosenberg, Yves; Mark, Daniel B.; Lee, Kerry L.; Packer, Douglas L.; Akoum, Nazem; Aoukar, Pierre S.; Birgersdotter‐Green, Ulrika; Blatt, Joseph A.; Mei, Yong; Chung, Mina K.; Gleva, Marye J.; Glotzer, Taya V.; Henrickson, Charles; Kron, Jack; Kuriachan, Vikas; Mulpuru, Siva K.; Noseworthy, Peter A.; Patton, Kristen K.; Prutkin, Jordan M.; Ranjan, Ravi; Rho, Robert W.; Russo, Andrea M.; Stecker, Eric C.; Tzou, Wendy S.; Serdoz, Laura Vitali; Wilson, Mauri

doi:10.1016/j.jacc.2020.04.065

Cited by 162 publications

(124 citation statements)

References 27 publications

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“…In a previous study with an average follow-up of 373 days, the AF recurrence was 13.8% 19 . In the CABANA trial recurrence assessment, the AF burden in 1 year in patients allocated to the ablation group was on average of 6.3% 20 . The recurrence rate described in this analysis was 9.6%.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Borges

Gazzoni

Yanez

et al. 2020

J Cardiac Arrhtythmias

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Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature.

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Section: Discussionmentioning

confidence: 99%

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Borges

Gazzoni

Yanez

et al. 2020

J Cardiac Arrhtythmias

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“…Catheter ablation is effective in reducing the burden of both paroxysmal and persistent atrial fibrillation In the largest catheter ablation trial to date, the CABANA trial, which randomized 2204 patients with atrial fibrillation to catheter ablation or drug therapy, catheter ablation reduced recurrences of atrial fibrillation by 48% compared with antiarrhythmic drug therapy over five years of follow-up. In the trial, the patients in the catheter ablation group experienced significant reduction in both first recurrence of any symptomatic or asymptomatic atrial fibrillation (hazard ratio 0.52, 0.45 to 0.60; P<0.001) or first symptomatic-only atrial fibrillation (0.49, 0.39 to 0.61; P<0.001) at five years of follow-up 153. In the recent CIRCA-DOSE trial—in which 346 patients with drug refractory paroxysmal atrial fibrillation were randomized to contact force guided radiofrequency ablation (n=115), four minute cryoballoon ablation (n=115), or two minute cryoballoon ablation (n=116)—catheter ablation with radiofrequency or cryoballoon resulted in freedom from atrial tachyarrhythmias in slightly more than half of patients, without a difference between ablation approaches (53.9%, 52.2%, and 51.7% with force guided radiofrequency ablation, four minute cryoballoon ablation, and two minute cryoballoon ablation, respectively; P=0.87) 154.…”

Section: Role Of Rhythm Controlmentioning

confidence: 99%

Screening and management of atrial fibrillation in primary care

Ponamgi

Siontis

Rushlow

et al. 2021

BMJ

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Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.

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“…This was also substantiated by CA-BANA trial data that showed that when AF recurred after catheter ablation, it was more likely to be asymptomatic-at 5 years, freedom from recurrence of symptomatic AF episodes was approximately 80%. 4 Health-related QoL was also significantly improved at 12 months in the ablation group vs medical therapy. 5 In the systematic review from…”

mentioning

confidence: 89%

“…However, there was a substantial and clinically important benefit of catheter ablation over drug therapy in reducing recurrent symptomatic and asymptomatic AF over 5 years of follow up. 4 There were also clinically important and significant improvements in QoL at 12 months in symptomatic patients. 5 There was also a signal for decreased cardiovascular hospitalizations, although not centrally adjudicated, and there may be a signal for mortality benefit of catheter ablation in the subgroup of patients with systolic dysfunction.…”

mentioning

confidence: 91%

“…In the intention‐to‐treat analysis, this trial did not demonstrate statistically significant differences between catheter ablation and antiarrhythmic drug therapy with regard to the primary composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest. However, there was a substantial and clinically important benefit of catheter ablation over drug therapy in reducing recurrent symptomatic and asymptomatic AF over 5 years of follow up 4 . There were also clinically important and significant improvements in QoL at 12 months in symptomatic patients 5 .…”

mentioning

confidence: 98%

See 1 more Smart Citation

Surgical ablation for atrial fibrillation: Breaking the bank or worth every penny?

Lambrakos

Goldberger

2020

J Card Surg

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Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial

Cited by 162 publications

References 27 publications

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Screening and management of atrial fibrillation in primary care

Surgical ablation for atrial fibrillation: Breaking the bank or worth every penny?

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