Name:
Monteleone: Review of the CABANA Trial
Description:
Monteleone: Review of the CABANA Trial
Thumbnail URL:
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Duration:
T00H04M07S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/dde80f43-0acb-4742-a6c1-5af700367f62/Monteleone-20Review20of20the20CABANA20Trial.mov?sv=2019-02-02&sr=c&sig=PqNByQWNk349%2ByW69Sz%2BNJKZGj0W3IzVGuJ8VT%2BLIT8%3D&st=2024-04-30T00%3A18%3A03Z&se=2024-04-30T02%3A23%3A03Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
♪ UPBEAT MUSIC: ♪
DR. BERNIE: The issue is: is it a very good trial, or is it a very good trial but not necessarily the trial to answer the question-- or didn't answer the question to enough satisfaction. So, anyway, that's the CABANA Trial.
♪ UPBEAT MUSIC: ♪ Hi, Dr. Bernie here, and welcome to Practice Impact Extra. In the past decade, there's been a significant increase in catheter ablation treatment for atrial fibrillation. Yet, the question remains: is it really superior to medical treatment? The CABANA trial was designed by investigators to answer this question: In symptomatic patients with the risk for stroke, is atrial fibrillation ablation superior to rate or rhythm control medication for the reduction of major outcomes?
♪ UPBEAT MUSIC: This trial dominated the Heart Rhythm Society meeting in May of 2018. The trial randomly assigned 1,100 patients to each group. Inclusion criteria included paroxysmal, or long-standing, atrial fibrillation, and more than half of the patients did have persistent atrial fib. The primary outcome was death, disabling stroke, serious bleeding, or cardiac arrest at five years.
♪ UPBEAT MUSIC: After five years of follow-up, there was no significant differences in the primary endpoint, and none of the components of the primary endpoint differed significantly. These results were presented in the standard intention-to-treat manner, which means patients who crossed over to the medical arm or, too, from the medical arm to ablation treatment were counted in the group they originally started from. The trial analysts created controversy when the results were presented on treatment basis, not from an intention-to-treat aspect.
♪ UPBEAT MUSIC: Nearly one third of the patients in the drug management arm did go on to ablation in their five year follow-up. 10% of those assigned to ablation did not even have ablation, but were on drug management. Looking at the analysis as treated, ablation did better and actually reduced the rate of the primary endpoint by 27%. The trial did confirm that this trend, which was seen in the CASTLE Atrial Fib Trial, did show a reduction in heart mortality secondary to atrial fibrillation ablations in patients with heart failure.
♪ UPBEAT MUSIC: So, what's the message here looking at the CABANA trial? The results of this important trial indicate that ablation is not superior to drug therapy for cardiovascular outcomes at five years among patients with new, onset, or untreated atrial fibrillation that did require therapy. However, there was a significant reduction in death or cardiovascular hospitalization with ablation on the as-treatment analysis and ablation did demonstrate superior efficacy compared to drug therapy.
♪ UPBEAT MUSIC: The significant cross-over rate really confused some of the assessment. My feeling is we need more. What do we need? We really need to have a sham-controlled trial of atrial fibrillation ablation. I think that would give us a better look at whether or not atrial fibrillation ablation or medical management is the superior way to go for treatment of patients with atrial fibrillation.
♪ UPBEAT MUSIC: So, thanks for joining me, and I'll see you next time on Practice Impact Extra.