Study: Ablation Improves Quality of Life and Symptoms Compared to Drug Therapy

Among patients with symptomatic atrial fibrillation (AFib), catheter ablation led to significant improvements in quality of life (QOL) at 12 months compared with drug therapy. These findings were published in JAMA.

In this open-label randomized clinical study known as the Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, researchers enrolled 2,204 patients (average age, 68; 63% men; 43% with paroxysmal AFib; 57% with persistent AFib) from 126 centers in 10 countries with symptomatic AFib and at least one risk factor for stroke. Patients were recruited from November 2009 to April 2016, with follow-up concluding in December 2017. The study interventions included pulmonary vein isolation, with additional ablation procedures left to the discretion of the researchers, for the catheter group (n=1,108) and standard rhythm and/or rate-control drugs selected and overseen by researchers for the drug therapy group (n=1,096).

The main study outcome measures were prespecified co-primary QOL end points at 12 months, including the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary score (range, 0-100, with zero indicating complete disability and 100 denoting no disability), and the Mayo AFib-Specific Symptom Inventory (MAFSI) frequency score (range, 0-40, with zero indicating no symptoms and 40 suggesting the more severe symptoms), and severity score (range, 0-30, with zero denoting no symptoms and 30 suggesting the most severe symptoms).

Catheter Ablation Favorable

According to the study’s findings, the mean AFEQT summary score was more favorable for catheter ablation group juxtaposed with the drug therapy group at 12 months (86.4 points vs. 80.9 points) (adjusted difference, 5.3 points [95% CI, 3.7 to 6.9]). The average MAFSI frequency score was also more favorable for the catheter ablation group compared to the drug therapy group at 12 months (6.4 points vs. 8.1 points; adjusted difference, -1.7 points; 95% CI, -2.3 to -1.2), and the average MAFSI severity score was better for the catheter ablation group than the drug therapy group at 12 months (5.0 points vs. 6.5 points; adjusted difference, -1.5 points; 95% CI, -2.0 to -1.1).

“Our study results complement what we have seen in the CABANA trial itself and suggest that ablation may be associated with a lower risk of cardiovascular events than medical therapy alone,” said Peter Noseworthy, MD, a Mayo Clinic cardiologist and lead researcher, in a press release about the study. “However, the benefit may be smaller in patients who would have been excluded from the trial. Trial eligibility criteria could serve as a guide for selecting patients who may more likely benefit from ablation for cardiovascular risk reduction.”