Controversial CABANA and CASTLE-AF trials discussed at Venice Arrhythmias

Luigi Di Biase (New York, USA) talks to BLearning Cardio at Venice Arrhythmias 2019 (3-5 October; Venice, Italy) about the results of the “controversial” CABANA trial which showed that catheter ablation is “superior to any medication” in improving freedom from atrial fibrillation (AF), symptoms and quality of life (QOL) for patients with AF. Among the 2,204 randomised patients, the catheter ablation group showed a superior mean Atrial Fibrillation Effect on Quality of Life (AFEQT) score than the drug therapy group at 12 months (86.4 points vs 80.9 points). In terms of AF recurrence, the ablation group also fared better (49.9% compared with 69.5%; p<0.001). However, catheter ablation, compared with medical therapy, did not significantly reduce the primary composite end point of death, disabling stroke, serious bleeding, or cardiac arrest (8% versus 9.2%, respectively; hazard ratio, 0.86; p=0.30). The results, notes Di Biase, outline the need to “discourage” the notion that catheter ablation should not be performed.

Di Biase also discusses the CASTLE-AF trial which looked at patients with heart failure and reduced ejection fraction, and ultimately showed “superiority of catheter ablation” when compared with medication in regards to mortality and rehospitalisation. The findings of the CASTLE-AF trial showed that the incidence of death or hospitalisation for heart failure, occurred in 28.5% of the catheter ablation group compared with 44.6% for the control group (p=0.007). Di Biase tells BLearning that these data are consistent with the AATAC trial that first showed the relevance of ablation in HFrEF (reduced ejection fraction) when compared to Amiodarone.

He concludes that there is now “a body of evidence to support catheter ablation” in patients with heart failure and reduced ejection fraction adding that clinicians and patients should start thinking about ablation “earlier” in the treatment pathway.

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Di Biase, Luigi

Luigi Di Biase is Section Head of Electrophysiology, Director of Arrhythmia Services, and Professor of Medicine (Cardiology) at Einstein/Montefiore in New York. In addition, he serves as Senior Researcher at the Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.

Di Biase is a member of the Italian Federation of Cardiology and Electrophysiology (FIC-AIAC), the European Society of Cardiology (ESC), the European Heart Rhythm Association (EHRA), the American College of Cardiology (ACC), the American Heart Association (AHA), and a Fellow of the Heart Rhythm Society (FHRS), and the American College of Cardiology (FACC). He is also an honorary member of the Korean Society of Cardiology.

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