BACKGROUND: Rhythm control strategies for atrial fibrillation (AF), including catheter ablation, are substantially underused in racial/ethnic minorities in North America. OBJECTIVES: This study sought to describe outcomes in the CABANA trial as a function of race/ethnicity. METHODS: CABANA randomized 2,204 symptomatic participants with AF to ablation or drug therapy including rate and/or rhythm control drugs. Only participants in North America were included in the present analysis, and participants were subgrouped as racial/ethnic minority or nonminority with the use of National Institutes of Health definitions. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. RESULTS: Of 1,280 participants enrolled in CABANA in North America, 127 (9.9%) were racial and ethnic minorities. Compared with nonminorities, racial and ethnic minorities were younger with median age 65.6 versus 68.5 years, respectively, and had more symptomatic heart failure (37.0% vs 22.0%), hypertension (92.1% vs 76.8%, respectively), and ejection fraction <40% (20.8% vs 7.1%). Racial/ethnic minorities treated with ablation had a 68% relative reduction in the primary endpoint (adjusted hazard ratio [aHR]: 0.32; 95% confidence interval [CI]: 0.13-0.78) and a 72% relative reduction in all-cause mortality (aHR: 0.28; 95% CI: 0.10-0.79). Primary event rates in racial/ethnic minority and nonminority participants were similar in the ablation arm (4-year Kaplan-Meier event rates 12.3% vs 9.9%); however, racial and ethnic minorities randomized to drug therapy had a much higher event rate than nonminority participants (27.4% vs. 9.4%). CONCLUSION: Among racial or ethnic minorities enrolled in the North American CABANA cohort, catheter ablation significantly improved major clinical outcomes compared with drug therapy. These benefits, which were not seen in nonminority participants, appear to be due to worse outcomes with drug therapy. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508).
BACKGROUND: Rhythm control strategies for atrial fibrillation (AF), including catheter ablation, are substantially underused in racial/ethnic minorities in North America. OBJECTIVES: This study sought to describe outcomes in the CABANA trial as a function of race/ethnicity. METHODS: CABANA randomized 2,204 symptomatic participants with AF to ablation or drug therapy including rate and/or rhythm control drugs. Only participants in North America were included in the present analysis, and participants were subgrouped as racial/ethnic minority or nonminority with the use of National Institutes of Health definitions. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. RESULTS: Of 1,280 participants enrolled in CABANA in North America, 127 (9.9%) were racial and ethnic minorities. Compared with nonminorities, racial and ethnic minorities were younger with median age 65.6 versus 68.5 years, respectively, and had more symptomatic heart failure (37.0% vs 22.0%), hypertension (92.1% vs 76.8%, respectively), and ejection fraction <40% (20.8% vs 7.1%). Racial/ethnic minorities treated with ablation had a 68% relative reduction in the primary endpoint (adjusted hazard ratio [aHR]: 0.32; 95% confidence interval [CI]: 0.13-0.78) and a 72% relative reduction in all-cause mortality (aHR: 0.28; 95% CI: 0.10-0.79). Primary event rates in racial/ethnic minority and nonminority participants were similar in the ablation arm (4-year Kaplan-Meier event rates 12.3% vs 9.9%); however, racial and ethnic minorities randomized to drug therapy had a much higher event rate than nonminority participants (27.4% vs. 9.4%). CONCLUSION: Among racial or ethnic minorities enrolled in the North American CABANA cohort, catheter ablation significantly improved major clinical outcomes compared with drug therapy. These benefits, which were not seen in nonminority participants, appear to be due to worse outcomes with drug therapy. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508).
Authors: Mohit K Turagam; Jalaj Garg; Samantha Sartori; Srinivas R Dukkipati; Vivek Y Reddy Journal: Ann Intern Med Date: 2019-07-02 Impact factor: 25.391
Authors: Kevin L Thomas; Mark A East; Eric J Velazquez; Robert H Tuttle; Linda K Shaw; Christopher M O'Connor; Eric D Peterson Journal: Am J Cardiol Date: 2005-10-01 Impact factor: 2.778
Authors: Daniel B Chastain; Sharmon P Osae; Andrés F Henao-Martínez; Carlos Franco-Paredes; Joeanna S Chastain; Henry N Young Journal: N Engl J Med Date: 2020-08-11 Impact factor: 91.245
Authors: Ross J Hunter; Thomas J Berriman; Ihab Diab; Ravindu Kamdar; Laura Richmond; Victoria Baker; Farai Goromonzi; Vinit Sawhney; Edward Duncan; Stephen P Page; Waqas Ullah; Beth Unsworth; Jamil Mayet; Mehul Dhinoja; Mark J Earley; Simon Sporton; Richard J Schilling Journal: Circ Arrhythm Electrophysiol Date: 2014-01-01
Authors: Peter A Noseworthy; Bernard J Gersh; David M Kent; Jonathan P Piccini; Douglas L Packer; Nilay D Shah; Xiaoxi Yao Journal: Eur Heart J Date: 2019-04-21 Impact factor: 29.983
Authors: Daniel B Mark; Kevin J Anstrom; Shubin Sheng; Jonathan P Piccini; Khaula N Baloch; Kristi H Monahan; Melanie R Daniels; Tristram D Bahnson; Jeanne E Poole; Yves Rosenberg; Kerry L Lee; Douglas L Packer Journal: JAMA Date: 2019-04-02 Impact factor: 56.272
Authors: Jonathan S Steinberg; Ara Sadaniantz; Jack Kron; Andrew Krahn; D Marty Denny; James Daubert; W Barton Campbell; Edward Havranek; Katherine Murray; Brian Olshansky; Gearoid O'Neill; Magdi Sami; Stanley Schmidt; Randle Storm; Miguel Zabalgoitia; John Miller; Mary Chandler; Elaine M Nasco; H Leon Greene Journal: Circulation Date: 2004-03-29 Impact factor: 29.690
Authors: Harsh Golwala; Larry R Jackson; DaJuanicia N Simon; Jonathan P Piccini; Bernard Gersh; Alan S Go; Elaine M Hylek; Peter R Kowey; Kenneth W Mahaffey; Laine Thomas; Gregg C Fonarow; Eric D Peterson; Kevin L Thomas Journal: Am Heart J Date: 2015-12-30 Impact factor: 4.749
Authors: Sofia E Gomez; Muhammad Fazal; Julio C Nunes; Shayena Shah; Alexander C Perino; Sanjiv M Narayan; Kamala P Tamirisa; Janet K Han; Fatima Rodriguez; Tina Baykaner Journal: J Interv Card Electrophysiol Date: 2022-10-13 Impact factor: 1.759