Update on CABANA

Critically important trial is off the ground

The Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) moves forward strong. Supported by the National Heart, Lung, and Blood Institute, Douglas L. Packer, M.D., principal investigator, and Kristi H. Monahan, R.N., director, excitedly report randomization of nearly 500 of the required 3,000 patients. More than 120 sites from the U.S., Canada, Germany, U.K., Russia, France, Italy, Czech Republic, Korea, Taiwan, Australia, China and Brazil are participating.

Establishing the appropriate roles for medical and ablative intervention for atrial fibrillation (AF) in patients with new onset or undertreated AF remains the focus, including quality of life and economics. Specifically, patients at risk of mortality, stroke and other health-related complications associated with AF are being enrolled.

Current guidelines recommend medicines as first line therapy

This recommendation, by definition, requires polypharmacy. Many patients require rate control; others require anti-arrhythmic drugs, while patients at risk of stroke require anti-thrombotic therapy. Many health care providers remain unenthusiastic about the limited efficacy and increased proarrhythmic risks of anti-arrhythmic drugs.

Literature reports

Observational studies show documented elimination rates for persistent atrial fibrillation (PAF) of 55 to 80 percent with lasso guidance and 70 to 90 percent success rate using more-aggressive approaches. No large prospective trial comparing medicines with ablation with respect to endpoints like mortality and major cardiovascular events exist. The impact of these treatments on quality of life and economics remain a mystery as well. Hence, the outcomes from CABANA are critical.

Patients with new or revised treatment within the preceding six months are eligible. For more information as a trial site or to refer patients to CABANA, go to ClinicalTrials.gov (NCT00911508), email cabana@mayo.edu or call 507-255-6676.