In patients with symptomatic atrial fibrillation, catheter ablation may be more effective than drug therapy in restoring sinus rhythm, according to a study published in JAMA.1

While early trials have found that catheter ablation is more effective than drug therapy in improving quality of life for patients with atrial fibrillation,2-5 these studies were limited by relatively small sample size, a narrow spectrum of patients with atrial fibrillation, and short duration of follow-up. Therefore, researchers from 126 centers in 10 countries conducted an open-label randomized clinical trial of catheter ablation compared with drug therapy in 2204 symptomatic patients with atrial fibrillation older than 65 years, or 65 years or younger with at least one risk factor for stroke (ClinicalTrials.gov identifier: NCT00911508).1

Patients in the catheter ablation group (n=1108) received pulmonary vein isolation with additional ablation procedures as needed, and patients in the drug therapy group (n=1096) received standard rhythm and/or rate-control drugs.

They found that among the study population, 946 had paroxysmal atrial fibrillation and 1257 had persistent atrial fibrillation. Compared with conventional medical therapy, catheter ablation significantly improved quality of life at one year as measured by the Atrial Fibrillation Effect on Quality of Life score and the Mayo Atrial Fibrillation-Specific Symptom Inventory frequency score and severity score.

In addition, patients in both treatment groups demonstrated clinically important improvements of approximately 20% to 50% in atrial fibrillation symptoms and quality of life scores relative to baseline values.

The authors concluded that “among patients with symptomatic atrial fibrillation, catheter ablation, compared with medical therapy, led to clinically important and significant improvements in quality of life at 12 months. These findings can help guide decisions regarding management of atrial fibrillation.”1

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Disclosure: Multiple authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.

References

  1. Mark DB, Anstrom KJ, Sheng S, et al; CABANA Investigators. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial [published online March 15, 2019]. JAMA. doi: 10.1001/jama.2019.0692
  2. Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012;367(17):1587-1595.
  3. Morillo CA, Verma A, Connolly SJ, et al; RAAFT-2 Investigators. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311(7):692-700.
  4. Wilber DJ, Pappone C, Neuzil P, et al; ThermoCool AF Trial Investigators. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303(4):333-340.
  5. Mark DB. Assessing quality-of-life outcomes in cardiovascular clinical research. Nat Rev Cardiol. 2016;13(5):286-308.