CATHETER ablation provides greater protection against serious cardiovascular outcomes compared to drug therapy in patients with atrial fibrillation who have fewer than three nonmodifiable recurrence risk factors, according to a new analysis of the CABANA trial. However, the benefit was not seen in patients with three or more of these risk factors.
Atrial fibrillation (AF) is a common heart rhythm disorder that increases the risk of stroke, cardiac arrest, and other major complications. While catheter ablation is already used to manage AF in certain patients, predicting which individuals gain the most benefit remains a challenge. Nonmodifiable risk factors, such as age, sex, long AF duration, and persistent AF type, may play a critical role in shaping treatment success.
Researchers carried out a secondary analysis of the CABANA trial, including 2,185 patients with AF and at least one stroke risk factor. Participants were assigned either catheter ablation or anti-arrhythmic drug therapy and grouped by the number of nonmodifiable recurrence risk factors they had: fewer than three, or three or more. Median age was 67 years, with men comprising 62.8 per cent of the study group. Among patients with fewer than three nonmodifiable risk factors, catheter ablation reduced the composite primary endpoint of death, disabling stroke, serious bleeding, or cardiac arrest compared to drug therapy (adjusted hazard ratio 0.59). For those with three or more risk factors, there was no significant difference in the primary outcome (adjusted hazard ratio 1.55). Regardless of risk group, ablation did not reduce all-cause mortality but did lower AF recurrence rates and improved quality of life scores related to symptom frequency throughout follow-up.
This evidence highlights the need for a more tailored approach to AF treatment, taking into account each patient’s unique risk profile. Future research is warranted to further refine selection criteria and optimise outcomes, ensuring that resources and invasive treatments are directed toward those most likely to benefit.
Reference
Wang Z 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.
