Arrhythmias & electrophysiology
Impact of atrial remodeling on efficacy of catheter ablation in reducing cardiovascular risk in atrial fibrillation: Results from CABANA trial
Authors' conclusion
In CABANA patients without enlarged LAD, catheter ablation significantly reduced major cardiovascular events while the prognostic benefits of ablation diminished with atrial remodeling aggravation. Ablation at the initial stage of atrial remodeling provided an effective early rhythm control strategy to reduce cardiovascular risk in AF.
Study context
- Population
- Patients with atrial fibrillation (AF) in the CABANA trial who underwent echocardiographic measurement for left atrial diameter (LAD) at baselinepatients with documented LAD at baseline (median LAD 44 mm), CABANA randomized 2204
- Participants
- 1,130 patients
- Comparison
- Ablation vs drug therapy, across extents of atrial remodeling
- Ablationn = 570
- Drug therapyn = 560reference
- Primary endpoint
- Composite of:
- Death
- Disabling stroke
- Serious bleeding
- Cardiac arrest
Methodological detailspost hoc analysis of patients with baseline echocardiographic LAD
- Post hoc analysis of patients with baseline echocardiographic LAD
Primary result
As reported in the abstract
ablation vs drug therapyAdjusted hazard ratio (95% CI)
Patients without enlarged LAD (LAD ≤ 40 mm)
0.30(0.11–0.78)
Patients with enlarged LAD (LAD > 40 mm)
0.92(0.55–1.54)
Further findings
| Outcome | Adjusted hazard ratio (95% CI) | |
|---|---|---|
| Total mortalityAblationvs drug therapyPatients without enlarged LAD | 0.09 (0.01–0.58) | |
| Total mortalityAblationvs drug therapyPatients with enlarged LAD | 0.76 (0.40–1.41) | |
| 0.050.21520Adjusted hazard ratio (log scale) |
- Total mortality: interaction P = .045
Original publication
Impact of atrial remodeling on efficacy of catheter ablation in reducing cardiovascular risk in atrial fibrillation: Results from CABANA trial. Heart Rhythm. Published 16 April 2025. doi:10.
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