Mortality benefit with AF ablation: Impact of normal sinus rhythm seen
in CABANA and EAST AF Net
Abstract
Atrial fibrillation is significantly associated with morbidity and
mortality and erodes the quality and quantity of life. It is standard of
care to treat patients with AF and an increased risk of stroke with oral
anticoagulation therapy, but the more daunting question many clinicians
face is whether to pursue a “rate-only” or “rhythm” control
strategy. Historical studies over the years have sought to answer this
question but have found no significant difference in major clinical
outcomes between the two strategies. There are opportunities based on
new data to improve the natural history of the disease. The EAST AFnet
trial for the first time revealed a significant morbidity and mortality
advantage to rhythm control therapy when performed early in the disease
process of AF and in the setting of comprehensive medical management
that was maintained. The CABANA trial clearly demonstrated that catheter
ablation was a more effective long-term treatment of AF in general and
significantly lowers risk of AF progression compared to medical therapy.
Like multiple prior trials of rhythm management strategies, when rhythm
control was effective in these trials, independent of therapy
assignment, there was a significantly lower risk of adverse outcomes and
death. These contemporary data provide optimism that the pervasive
mortality risk in patients with AF observed over the past 50 years may
be improved by the timing, use, and efficacy of use of therapeutic
interventions.