EAST in light of CABANA

Catheter ablation is safe in elderly patients with
atrial fibrillation, but not superior to drug therapy
with respect to cardiovascular outcomes at 5 years.
Secondary analyses suggest possible benefits of
catheter ablation. This is the headline finding of the
CABANA trial presentation at HRS in May 2018.

The detailed results of CABANA: Over 2000 patients
with symptomatic AF were randomised to ablation
or drug therapy (1,108 ablation; 1,096 drug
therapy). The mean age was 68 years, 37% were
female, BMI 30, 15% had heart failure, 10% prior
stroke, 43% paroxysmal AF, 1.1 years AF duration
prior to enrolment.

There was no difference in the primary outcome
(disabling stroke, death, or major bleeding) in the
main ITT analysis. The investigators observed 58 vs
67 deaths; 3 vs 7 disabling strokes, 36 vs 36 major
bleeds; and 7 vs 11 cardiac arrest. In a per protocol
analysis, the primary outcome was slightly less
common in patients randomised to ablation and undergoing
ablation (p=0.046, HR 0.73). Dr Douglas
Packer reported low complication rates: 4% periablation,
and 2% in the drug therapy arm. Patients
randomised to ablation had less recurrent AF.

The presentation of CABANA enhances the interest
in the results of EAST – AFNET 4, and also highlights
the need to collect cardiovascular outcomes.