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Effects of ablation versus drug therapy on clinical outcomes and quality of life by frailty status in atrial fibrillation: a post hoc analysis of the CABANA trial
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Effects of ablation versus drug therapy on clinical outcomes and quality of life by frailty status in atrial fibrillation: a post hoc analysis of the CABANA trial
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Effects of ablation versus drug therapy on clinical outcomes and quality of life by frailty status in atrial fibrillation: a post hoc analysis of the CABANA trial
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Journal Article
Effects of ablation versus drug therapy on clinical outcomes and quality of life by frailty status in atrial fibrillation: a post hoc analysis of the CABANA trial
2026
Overview
Background
Frailty is highly prevalent in patients with atrial fibrillation (AF) and is associated with adverse outcomes compared with non-frail individuals. This study aimed to explore whether the effects of ablation versus drug therapy on clinical outcomes and quality of life (QoL) differ according to frailty status in patients with AF.
Methods
This is a post hoc analysis of the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. The frailty index (FI) was calculated using 30 items, with an
FI
≥ 0.21 defined as frailty. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. The secondary outcomes included all-cause death and heart failure (HF) hospitalization. QoL was assessed periodically over 60 months using the Mayo AF-Specific Symptom Inventory (MAFSI).
Results
In this study, a total of 2189 and 2070 patients were included in the intention-to-treat (ITT) and per-protocol (PP) populations, respectively. Over a median follow-up of 1440 (
IQR
, 900–2880) days, 184 patients experienced the primary endpoint, 122 died, and 174 experienced HF hospitalizations. Compared with drug therapy, catheter ablation did not significantly reduce the risk of clinical outcomes, with no significant difference observed across frailty strata. Regarding QoL, patients with AF and frailty in the ablation group experienced significant improvement compared with those in the drug group: a mean difference among all follow-ups of − 1.58 (− 2.11 to − 1.06;
P
< 0.001) in the MAFSI frequency score and − 1.26 (− 1.69 to − 0.84,
P
< 0.001) in the MAFSI severity score. However, patients with AF and without frailty in the ablation group showed no significant QoL improvement compared with those in the drug group.
Conclusions
There is no significant difference in the effectiveness of reducing clinical outcomes of catheter ablation according to frailty status in patients with AF compared with drug therapy, while patients with AF and frailty could derive a higher QoL improvements from catheter ablation therapy. These findings highlight the potential role of catheter ablation in improving QoL for patients with AF and frailty.
Publisher
BioMed Central,Springer Nature B.V,BMC
