Non-Early Catheter Ablation Versus Drug Therapy in Atrial Fibrillation: Results from the CABANA Trial.

Background: Early rhythm control reduces the risk of cardiovascular events in patients with atrial fibrillation (AF). Despite the superiority of catheter ablation in maintaining sinus rhythm, the knowledge gaps regarding the prognostic benefits of non-early (onset of AF ≥1 year) ablation remain.

Objective: To describe outcomes of non-early AF in the CABANA trial.

Methods: CABANA randomized AF participants to catheter ablation or drug therapy. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Secondary endpoints included all-cause mortality, and all-cause mortality or cardiovascular hospitalization.

Results: A total of 2178 patients (median age 67 years; 810 [37.2%] female) were included, 1122 (51.5%) of whom with non-early AF. For the primary outcome, the adjusted hazard ratio (aHR) of ablation vs. drug therapy was 0.83 (95% CI 0.53-1.30, P=0.413) in non-early AF patients and 0.78 (95% CI 0.52-1.16, P=0.220) in early AF patients (interaction p-value =0.787). Non-early ablation resulted in a relative reduction of 26% and 23% in all-cause mortality (aHR 0.74, 95% CI 0.42-1.33, P=0.314) and all-cause mortality or cardiovascular hospitalization (aHR 0.77, 95% CI 0.65-0.91, P=0.002), respectively. After excluding patients with prior heart failure, non-early AF patients receiving ablation still had a significantly lower risk of all-cause mortality or cardiovascular hospitalization (aHR 0.78, 95% CI 0.65-0.93, P=0.005).

Conclusion: Non-early AF patients may benefit similarly from catheter ablation as early AF patients. Catheter ablation may be an effective treatment strategy to reduce the composite risk of all-cause mortality or cardiovascular hospitalization in non-early AF patients, regardless of heart failure history.