Impact of disease progression avoidance by catheter ablation on clinical outcomes in atrial fibrillation: Insights from the CABANA trial

Li, M; Guo, H; Li, E; Jiang, C; Zhao, M; Wang, Z; Wang, J; Shen, T; Xia, S; He, L; Dai, W; Guo, X; Li, S; Liu, N; Jiang, C; Tang, R; Long, D; Sang, C; Du, X; Dong, J; Ma, C

doi:10.1016/j.hrthm.2025.07.050

Impact of disease progression avoidance by catheter ablation on clinical outcomes in atrial fibrillation: Insights from the CABANA trial

Heart RhythmPublished 5 Aug 2025post hoc analysis of the CABANA trial

Primary result · Time to the first documented episode of persistent AF after a 90-day blanking period (AF progression)ResultAdjusted hazard ratio 0.52 95% CI 0.38–0.70

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Authors' conclusion

In this post hoc analysis of the CABANA trial, catheter ablation significantly reduced the occurrence of AF progression. The large randomized trial data provide proof of concept evidence that progression avoidance by ablation may be transformed into clinical outcome improvements.

Study context

Population: CABANA participants with paroxysmal atrial fibrillation (AF) at enrollmentpatients with paroxysmal AF at baseline among 2204 CABANA total population
Participants: 854 participants

Comparison: Catheter ablation with drug therapy
Ablation groupn = 413
Drug treatment groupn = 441reference
Primary endpoint: time to the first documented episode of persistent AF after a 90-day blanking period (AF progression)
Follow-up: Median 49.7 months

Methodological detailssubanalysis

Subanalysis

Primary result

As reported in the abstract

Adjusted hazard ratio

0.52

95% CI 0.38–0.70

Events by treatment group

Ablation group16.0%66 of 413

Drug treatment group27.7%122 of 441

Ablation groupvs drug treatment group

adjusted hazard ratio 0.52 (95% CI 0.38–0.70)

Further findings

Death or cardiovascular hospitalization, by AF progression (subgroup)

Among participants without AF progression, catheter ablation significantly reduced the incidence of death or cardiovascular hospitalization
No significant effect was observed among those who developed AF progression

Mediation analysis: share of treatment effect on death or cardiovascular hospitalization explained by AF progression avoidance

AF progression avoidance explained: 23.3%

Original publication

Impact of disease progression avoidance by catheter ablation on clinical outcomes in atrial fibrillation: Insights from the CABANA trial. Heart Rhythm. Published 5 August 2025. doi:10.1016/j.hrthm.2025.07.050

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