To the Editor The Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial found that catheter ablation did not significantly reduce the primary composite end point compared with medical therapy.1 The authors acknowledged that a substantial proportion of patients in the drug group (27.5%) crossed over and received ablation, which may have affected the results. There were significant baseline differences in age and symptom burden in patients who did and did not cross over (eTable 5 in Supplement 3 in the article1), but it is unclear what factors guided the decision to receive ablation. Whether the decision was driven by symptoms, personal preferences, or financial considerations was not stated. Regardless, the high percentage of crossover may have affected the outcomes of all presented analyses.
Lucijanic M, Skelin M, Skelin P. Catheter Ablation Compared With Drug Therapy for Atrial Fibrillation. JAMA. 2019;322(11):1105. doi:10.1001/jama.2019.10680
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