Association Between Age and Outcomes of Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: Results from the CABANA Trial

Circulation ◽  
2021 ◽  
Author(s):  
Tristram D. Bahnson ◽  
Anna Giczewska ◽  
Daniel B. Mark ◽  
Andrea M. Russo ◽  
Kristi H. Monahan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Relative Effectiveness ◽  
Age Groups ◽  
P Value ◽  
Recurrence Rates ◽  
All Cause Mortality

Background: Observational data suggest catheter ablation may be safe and effective to treat younger and older patients with atrial fibrillation (AF). No large randomized trial has examined this issue. This report describes outcomes according to age at entry in the Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation trial (CABANA). Methods: Patients with AF age ≥65, or <65 with ≥1 risk factor for stroke, were randomly assigned to catheter ablation versus drug therapy. The primary outcome was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Secondary outcomes included all-cause mortality, the composite of mortality or cardiovascular hospitalization, and recurrence of AF. Treatment effect estimates were adjusted for baseline covariables using proportional hazards regression models. Results: Of 2204 patients randomized in CABANA, 766 (34.8%) were age <65, 1130 (51.3%) were 65-74, and 308 (14.0%) were ≥75. Catheter ablation was associated with a 43% reduction in the primary outcome for age <65 patients (adjusted hazard ratio [aHR] 0.57, 95% confidence interval [CI] 0.30-1.09), a 21% reduction for age 65-74 (aHR 0.79; 95% CI 0.54-1.16), and an indeterminate effect for age ≥75 (aHR 1.39; 95% CI 0.75-2.58). Four year event rates for ablation versus drug therapy across age groups, respectively, were 3.2% versus 7.8%, 7.8% versus 9.6%, and 14.8% versus 9.0%. For every 10-year increase in age, the primary outcome aHR increased (i.e., less favorable to ablation) an average of 27% (interaction p value= 0.215). A similar pattern was seen with all-cause mortality: for every 10-year increase in age, the aHR increased an average of 46% (interaction p value= 0.111). AF recurrence rates were lower with ablation compared to drug therapy across age subgroups (aHR 0.47, 0.58, and 0.49, respectively). Treatment-related complications were infrequent for both arms (<3%) regardless of age. Conclusions: We found age-based variations in clinical outcomes for catheter ablation compared with drug therapy, with the largest relative and absolute benefits of catheter ablation in younger patients. No prognostic benefits for ablation were seen in the oldest patients. No differences were found by age in treatment-related complications or in the relative effectiveness of catheter ablation in preventing recurrent atrial arrhythmias.

P2832Outcomes of catheter ablation for atrial fibrillation based on sex: data from the cabana trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Poole ◽  
A M Russo ◽  
Y M Cha ◽  
K H Monahan ◽  
H R Al-Khalidi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Sleep Apnea ◽  
Catheter Ablation ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
P Value ◽  
Severe Bleeding ◽  
Jude Medical ◽  
All Cause Mortality

Abstract Background Sex-specific outcomes may differ amongst patients receiving catheter ablation for atrial fibrillation (AF). Purpose Assess sex-specific outcomes in the patients randomized to catheter ablation or drug therapy in CABANA. Methods CABANA randomized 2204 pts with AF to catheter ablation or drug therapy (rate/rhythm-control). The outcomes of combined death, disabling stroke, severe bleeding, or cardiac arrest (intention to treat-ITT) or all-cause death were not different. But, ablation significantly improved combined death or CV hospitalization. This analysis compares clinical characteristics by sex and determines sex-specific hazard ratios based on a comparison of ablation vs drug therapy. Results Females were 37.3% of ablation and 37.0% of drug therapy patients. Females were older, more often white race, had less CAD, or sleep apnea, but had higher NYHA Class, higher CHA2DS2VASc, and more often had paroxysmal (v. persistent) AF, and prior AF hospitalization. (Table) HTN, CVA and diabetes were the same (Table). For the CABANA primary endpoint, an ITT comparison of ablation vs. drug therapy, showed a female hazard ratio (HR) of 1.14 (95% confidence interval (CI) 0.70–1.86), and a male HR of 0.74, (95% CI 0.52–1.06). For all-cause mortality, the female HR was 0.75 (95% CI 0.41–1.40) and male HR was 0.91 (95% CI 0.59–1.40) and for all-cause mortality or CV hospitalization, the female HR was 0.90 (95% CI 0.75–1.09) and male HR was 0.79 (95% CI 0.69–0.92). All interaction p values were non-significant. Recurrent AF (post 90-day blanking) was significantly reduced for both females and males: female HR 0.64 (95% CI 0.51–0.82), male HR 0.46 95% CI 0.39–0.56), p=0.035 Clinical Characteristics and Outcomes Baseline Characteristics Female (N=818) Male (N=1385) p-value Age: Median (Q1, Q3) 69 (65, 74) 66 (60, 71) <0.001 White 766 (93.9%) 1259 (91.0%) 0.015 CAD 92 (11.2%) 332 (24.0%) <0.001 NYHA ≥II 345 (42.4%) 433 (31.5%) <0.001 Sleep apnea 136 (16.6%) 372 (26.9%) <0.001 CHA2DS2-VASc: Median (Q1, Q3) 3 (3, 4) 2 (1, 3) <0.001 Paroxysmal AF 406 (49.6%) 540 (39.0%) <0.001 Persistent AF 412 (50.4%) 845 (61.0%) AF Hospitalization 353 (43.2%) 521 (37.7%) 0.011 Conclusion Significant sex-specific outcomes differences were not observed. Sex should not be used as a determining factor in selecting patients for AF therapy. Acknowledgement/Funding NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation

P359Outcomes of radiofrequency catheter ablation of ischemic ventricular tachycardia in patients with electrical storm

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Oksul ◽  
H Yorgun ◽  
Y Z Sener ◽  
A H Ates ◽  
U Canpolat ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Effective Treatment ◽  
Mortality Rates ◽  
Electrical Storm ◽  
P Value ◽  
Effective Treatment Option ◽  
Recurrence Rates ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Background Electrical storm (ES) is defined as 3 or more episodes of sustained ventricular tachycardia (VT) within 24 hours and related with high mortality rates. Catheter ablation is an effective treatment option in patiens with ES.  Purpose   We aimed to evaluate outcomes of VT catheter ablation in patients with ES. Methods   All patients who underwent catheter ablation due to VT ablation between June 2014 and November 2018 were screened and outcomes of patients who admitted with ES were evaluated.  Results A total of 128 patients were included. 52 (40.6%) patients were admitted with ES. Mean age of the patients with ES was 68 ± 10,5 years and 48(92,3) patients were male. Median follow up was 22.5 (8-46)  months. Baseline characteristics were listed in Table- 1.Multivariate regression analysis revealed that hemoglobin level (HR:0.76, CI:0,61-0,94, p = 0.011 ) and antiarrhythmic drug use (HR:0.25, CI:0,10-0.62, p = 0.003) were predictors of ES development. Recurrence rates and number of re-do ablation procedures were significantly higher in patients with ES (Table-1). Cardiovascular and all cause mortality rates were also significantly higher in patients with ES (Table-1).  Conclusion Despite catheter ablation is an effective treatment in patients with ES; presence of ES is related with increased mortality and recurrence rates after ablation. Table-1 Patients with ES Patients without ES p value Age, years 68 ± 10,5 63,8 ± 8,8 0,017* Gender, male, n (%) 48(92,3) 72(94,7) 0,853 Hypetension, n (%) 34(65,4) 59(77,6) 0,158 Diabetes, n (%) 17(32,7) 18(23,7) 0,314 Previous PCI 32(61,5) 51(67,1) 0,574 NYHA &gt;II 17(32,7) 13(17,1) 0,044* LV EF, (%) 27,8 ± 8 29,1 ± 8,3 0,369 LV EDD, mm 64,6 ± 9,1 63,3 ± 8,2 0,431 Hemoglobin, g/dL 13,0 ± 2,1 14,1 ± 1,6 0,002* BNP level (pg/mL) 461(35-3161) 244(10-4517) 0,008* Recurrence 23(44,2) 21(27,6) 0,050* Re-do ablation 0,050* 8(10,5) 0,010* Cardiovascular mortality 16(34,8) 12(16,9) 0,045* All cause mortality 22(42,3) 17(22,4) 0,020* Baseline characteristics and outcomes of catheter ablation in patients with and without ES

Antiarrhythmic drug therapy and all-cause mortality after catheter ablation of atrial fibrillation: A propensity-matched analysis

Heart Rhythm ◽  
2019 ◽  
Vol 16 (9) ◽  
pp. 1368-1373 ◽  
Author(s):  
Ghanshyam Shantha ◽  
Daniel Alyesh ◽  
Hamid Ghanbari ◽  
Miki Yokokawa ◽  
Mohammed Saeed ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Antiarrhythmic Drug Therapy ◽  
All Cause Mortality

Antiarrhythmische Pharmakotherapie

2012 ◽  
Vol 31 (11) ◽  
pp. 826-829
Author(s):  
A. Goette ◽  
P. Kirchhof ◽  
A. Treszl ◽  
K. Wegscheider ◽  
T. Meinertz
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Angiotensin Ii ◽  
Catheter Ablation ◽  
Early Treatment ◽  
Stroke Prevention ◽  
Conventional Treatment ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Atrial Fibrillation Trial

ZusammenfassungEs werden die Ergebnisse von Studien sowie die Protokolle laufender „Megastudien“ mit Bezug zum Vorhofflimmer-Netzwerk dargestellt. Bei den abgeschlossenen Studien handelt es sich um die Flecainide Short-Long trial (Flec-SL) und die Angiotensin-II-Rezeptorblocker in Paroxysmal Atrial FibrillationStudie (ANTIPAF). Bei den „Megastudien“ um Studien mit den Kürzeln EAST (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), CABANA (Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) und CASTLE-AF (Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation). Die Ergebnisse der Studien: Eine präventive Kurzzeittherapie nach Kardio-version ist sinnvoller als der Verzicht auf jegliche Antiarrhythmika-Nachbehandlung. Noch effektiver scheint eine antiarrhythmische Langzeit-Nachbehandlung über sechs Monate zu sein. In der ANTIPAF-Studie zeigte sich, dass bei Patienten mit paroxysmalem Vorhofflimmern (VHF) ohne strukturelle Herzkrankheit der Angiotensinrezeptorblocker Olmesartan nicht in der Lage ist, die Häufigkeit der Anfälle zu reduzieren. Wichtigstes therapeutisches Ziel ist die Verhinderung der Progression von VHF. In der EAST-Studie wird geprüft, ob eine frühzeitig eingeleitete, „aggressive“ Therapie zur Kontrolle des Herzrhythmus eher in der Lage ist, Morbidität und Mortalität von VHF zu senken als die Standardtherapie.

scholarly journals Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Young Choi ◽  
Sung-Hwan Kim ◽  
Ju Youn Kim ◽  
Youmi Hwang ◽  
Tae-Seok Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Positive Pressure ◽  
Efficacy And Safety ◽  
Af Ablation ◽  
Hemodynamic Compromise ◽  
3D Mapping System ◽  
Sedative Agents

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

Abstract P172: Circulating Heat Shock Protein 70 and Antiheat Shock Protein 70 Antibodies in Atrial Fibrillation: Relation with Atrial Fibrillation Type and Response to Catheter Ablation

2011 ◽  
Vol 109 (suppl_1) ◽  
Author(s):  
Jelena Kornej ◽  
Claudia Reinhardt ◽  
Jedrzej Kosiuk ◽  
Arash Arya ◽  
Gerhard Hindricks ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Heat Shock ◽  
Heat Shock Protein ◽  
Heat Shock Protein 70 ◽  
Recurrence Rates ◽  
Multivariable Regression Analysis ◽  
Multivariable Regression ◽  
Af Recurrence

Background: HSP and anti-HSP antibodies have been associated with AF development and progression. This study investigated the possible association between circulating heat shock protein 70 (HSP70) and anti-HSP70 antibodies as well their changes and rhythm outcome after atrial fibrillation (AF) catheter ablation. Methods: In 67 patients with AF (59±11 years, 66 % male, 66 % lone AF) undergoing catheter ablation, circulating HSP70 and anti-HSP70 antibodies levels were quantified before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. Results: At baseline, HSP70 was detectable in 14 patients (21 %), but there was no correlation between clinical or echocardiographic variables and the presence or the level of HSP70. Patients with paroxysmal AF (n=39) showed lower anti-HSP70 antibodies (median 43, IQR 28 - 62 µg/ml) than patients with persistent AF (n=28; 53, 41 - 85 µg/ml, p=.035). Using multivariable regression analysis, AF type was the only variable associated with anti-HSP70 antibodies (Beta=.342, p=.008). At 6 months, HSP70 was present in 27 patients (41 %, p<.001 vs. baseline) with an overall increase (median 0, IQR 0 - 0 vs. 0, 0 - 0.09 ng/ml, p=.029). Similarly, there was an increase of anti-HSP70 antibodies (48, 36 - 72 vs. 57, 43 - 87 µg/ml, p<.001). AF recurrence rates were higher in patients with HSP70 increase >0.025 ng/ml (32 vs. 11 %, p=.038) or anti-HSP70 antibodies increase >2.5 µg/ml (26 vs. 4 %, p=.033). Conclusion: HSP70 and anti-HSP70 antibodies may be involved in the progression of AF and AF recurrence after catheter ablation.

scholarly journals Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Schleberger ◽  
A Metzner ◽  
K H Kuck ◽  
D Andresen ◽  
S Willems ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Treatment Satisfaction ◽  
Cardiovascular Events ◽  
Patient Reported Outcome ◽  
Antiarrhythmic Drug Therapy ◽  
Funding Sources ◽  
Patient Reported

Abstract Background Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden. Methods Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome. Results In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]). Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD. Conclusion The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. FUNDunding Acknowledgement Type of funding sources: None.

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