Catheter Ablation Beats Drug Therapy in Atrial Fibrillation Patients With Lower Risk Factors: CABANA Subanalysis
China: A new secondary analysis of the Catheter Ablation vs Anti-Arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial suggests that the benefit of catheter ablation over drug therapy in atrial fibrillation (AF) largely depends on the patient’s burden of non-modifiable recurrence risk factors (NMRRFs).
The study, led by Zhen Wang and colleagues from the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, was published in JAMA Network Open.
Although catheter ablation is widely used to manage AF, large-scale evidence comparing its impact on outcomes across different recurrence risk profiles has been limited. To address this, researchers examined whether the number of NMRRFs—factors that cannot be altered—modifies the relative benefit of ablation compared with anti-arrhythmic drug therapy.
The analysis included 2,185 patients from the original CABANA trial who had complete NMRRF data. These patients were classified into two groups: those with fewer than three NMRRFs and those with three or more. The NMRRFs assessed were AF duration over one year, persistent or long-standing persistent AF, age over 65, and female sex.
The key findings of the study were as follows:
- The study analyzed 2,185 participants with a median age of 67 years, of whom 62.8% were male.
- A total of 1,100 patients were assigned to catheter ablation, while 1,085 received drug therapy.
- Nearly 67.2% of patients had fewer than three nonmodifiable recurrence risk factors (NMRRFs).
- In patients with fewer than three NMRRFs, catheter ablation significantly reduced the primary composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest (adjusted hazard ratio [AHR], 0.59).
- No significant benefit in the primary composite outcome was observed in patients with three or more NMRRFs (AHR, 1.55).
- Across all groups, catheter ablation did not lower all-cause mortality, but consistently reduced atrial fibrillation (AF) recurrence and improved quality of life during follow-up.
- AF recurrence rates were substantially lower with ablation (<3 NMRRFs: AHR, 0.46; ≥3 NMRRFs: AHR, 0.58).
- Symptom burden decreased in both subgroups, indicating quality-of-life improvement with ablation.
“These findings indicate that catheter ablation could substantially improve cardiovascular outcomes in AF patients with fewer than three non-modifiable recurrence risk factors,” the authors noted. The study supports a tailored approach to AF management, focusing ablation efforts on patients most likely to benefit.
However, researchers acknowledged limitations, including its post hoc design, lack of stratified randomization, and potential selection bias due to incomplete NMRRF data. Additionally, the underrepresentation of certain subgroups, such as those with advanced heart failure, limits generalizability.
"For patients with AF and fewer than three NMRRFs, catheter ablation appears to confer significant prognostic benefits compared with drug therapy. In those with higher risk profiles, ablation remains useful for symptom control and recurrence reduction, highlighting the need for personalized treatment strategies," the authors concluded.
Reference:
Wang Z, Wu Y, Jiang C, et al. Catheter Ablation vs Drug Therapy in Patients With Atrial Fibrillation and Nonmodifiable Recurrence Risk Factors: A Secondary Analysis of the CABANA Randomized Clinical Trial. JAMA Netw Open. 2025;8(8):e2528124. doi:10.1001/jamanetworkopen.2025.28124
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