The CABANA Trial
Dr. Piña: And getting all their blood work in between. In another one of our programs, we talked about the CABANA trial. Tell us a little bit about CABANA. What is different about this registry vs CABANA?
Dr. Calkins: CABANA is like AFFIRM. It is a prospective randomized clinical trial of 2 different strategies, and it is a very interesting study design. Study participants are patients with AF who have an increased risk for stroke and adverse events. They are older than 65 years of age or have stroke risk factors, and they get randomly assigned to treatment of AF with drug therapy or catheter ablation. They are looking long-term at the hard endpoints: Does ablation strategy improve mortality and lower stroke risk? AFFIRM was criticized because they tried a rhythm-control strategy but used antiarrhythmic drugs that weren't effective and caused proarrhythmia. Now, with CABANA, we have a strategy that doesn't have proarrhythmia and that is more effective. Therefore, we are going to see the benefit of AF ablation.
Dr. Piña: You said that one arm of CABANA is drug protocols. Are they in a protocol form or can you use whatever you want?
Dr. Calkins: You can use whatever you want.
Dr. Piña: So, what would you use for your patients?
Dr. Calkins: If a patient has minimal symptoms, they may just go with rate control. If not, I will usually start with an antiarrhythmic drug. Flecainide or propafenone is usually first. If that doesn't work, I use sotalol or possibly amiodarone. It is really wide open, what you choose and when you move from one to another. It is a very practical study looking at 2 strategies, and I think the results will be very important. We are all looking forward to them.
Dr. Piña: I think more and more studies are looking at strategies as opposed to just this drug versus that drug or this procedure versus that procedure. In the heart failure world, we are starting to think that way as well. You guys were ahead of us on thinking about strategies of care.
Cite this: Treating AF: Reducing Stroke Risk With Ablation - Medscape - Nov 04, 2013.