Reflections on CABANA Trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial)

Reflexões sobre o Estudo CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial)

  • José Tarcísio Medeiros de Vasconcelos
Keywords: CABANA Trial, cardiac arrhythmia

Abstract

Atrial fibrillation has been consolidated in recent decades as a serious public health problem, considering its notorious increase in prevalence with aging combined with increased population survival. Data from the Framingham Heart Study indicate that, even in an optimal scenario of absence of classic risk factors for its occurrences, such as smoking, alcohol abuse, obesity, hypertension, diabetes, and heart disease, about 10% of individuals aged 80 or over and about 25% of those aged 90 or over will have atrial fibrillation. These rates substantially increase when added to single or combined risk factors. Despite its already well-known association with the occurrence of thromboembolic stroke, the presence of atrial fibrillation has been identified as an independent mortality risk factor in large population studies.

References

Staerk L, Wang B, Preis SR, Larson MG, Lubitz SA, Ellinor PT, McManus DD, Ko D, Weng L-C, Lunetta KL, Frost L, Benjamin EJ, Trinquart L. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. Brit Medic J. 2018;361:1-10 https://doi.org/10.1136/bmj.k1453

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Strok. 1991;22(8):983-88. https://doi.org/10.1161/01.STR.22.8.983

Andersson T, Magnuson A, Bryngelsson IL, Frøbert O, Henriksson KM, Edvardsson N, et al. All-cause mortality in 272, 186 patients hospitalized with incident atrial fibrillation 1995–2008: A Swedish nationwide long-term case–control study. Eur Heart J. 2013;34(14):1061-67. https://doi.org/10.1093/eurheartj/ehs469

Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K, et al. Catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation (CABANA) trial: study rationale and design. Am Heart J. 2018;199:192-99. https://doi.org/10.1016/j.ahj.2018.02.015

Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation. CABANA Rand Clinic Trial. 2019;321(13):1261-274. https://doi.org/10.1001/jama.2019.0693

Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure (CASTLE-AF). N Engl J Med. 2018;378(5):417-27. https://doi.org/10.1056/NEJMoa1707855

Leong DP, Eikelboom JW, Healey JS, Connolly SJ. Atrial fibrillation is associated with increased mortality: causation or association? Europ Heart J. 2013;34(14):1027-30. https://doi.org/10.1093/eurheartj/eht044

Published
17-10-2019
Section
Editorial