Trial Search Results
Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial
The (Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) CABANA Trial has the overall goal of establishing the appropriate roles for medical and ablative intervention for atrial fibrillation (AF). The CABANA Trial is designed to test the hypothesis that the treatment strategy of left atrial catheter ablation for the purpose of eliminating atrial fibrillation (AF) will be superior to current state-of-the-art therapy with either rate control or rhythm control drugs for decreasing the incidence of the composite endpoint of total mortality, disabling stroke, serious bleeding, or cardiac arrest in patients with untreated or incompletely treated AF.
Stanford is currently not accepting patients for this trial.
Collaborator: Biosense Webster, Inc.
- Device: Left atrial ablation
- Drug: Rate or Rhythm Control Therapy
- Over the preceding 6 months have:
1. ≥2 paroxysmal (electrocardiographic documentation of at least 1) atrial
fibrillation (AF) episodes lasting ≥1 hour in duration: (that terminate
spontaneously within 7 days or cardioversion is performed within 48h of AF
2. electrocardiographic documentation of 1 persistent AF episode: (sustained for ≥7
days or cardioversion is performed more than 48h after AF onset): or
3. electrocardiographic documentation of 1 longstanding persistent AF episode:
(continuous AF of duration >1 year).
- Warrant active therapy (within the past 3 months) beyond simple ongoing observation
- Be eligible for catheter ablation and ≥2 sequential rhythm control and/or ≥2 rate
- Be ≥65 yrs of age, or <65 yrs with one or more of the following risk factors for
stroke: Hypertension (treated and/or defined as a blood pressure >140/90 mmHg) ,
Diabetes (treated and/or defined as a fasting glucose ≥126 mg/dl) , Congestive
heart failure (including systolic or diastolic heart failure), Prior stroke, transient
ischemic attack or systemic emboli, Atherosclerotic vascular disease (previous
myocardial infarction (MI), peripheral arterial disease or aortic plaque), left atrial
(LA) size >5.0 cm (or volume index ≥40 cc/m2), or ejection fraction (EF) ≤35.
- Have the capacity to understand and sign an informed consent form.
- Be ≥18 years of age.
- NOTE- Subjects <65 yrs of age whose only risk factor is hypertension must have a
second risk factor or left ventricular (LV) hypertrophy to qualify.Patients
receiving new drug therapy initiated within the previous 3 months may continue
that therapy if randomized to the drug therapy arm. Patients may have documented
atrial flutter in addition to atrial fibrillation and remain eligible for
- Lone AF in the absence of risk factors for stroke in patients <65 years of age
- Patients who in the opinion of the managing clinician should not yet receive any
therapy for AF
- Patients who have failed >2 membrane active anti-arrhythmic drugs at a therapeutic
dose due to inefficacy or side effects (Table 5.2.2)
- An efficacy failure of full dose amiodarone treatment >8 weeks duration at any time
- Reversible causes of AF including thyroid disorders, acute alcohol intoxication,
recent major surgical procedures, or trauma
- Recent cardiac events including MI, percutaneous intervention (PCI), or valve or
bypass surgery in the preceding 3 months
- Hypertrophic obstructive cardiomyopathy (outflow track)
- Class IV angina or Class IV congestive heart failure (CHF) (including past or planned
- Other arrhythmias mandating anti-arrhythmic drug therapy (i.e. ventricular tachycardia
(VT), ventricular fibrillation (VF))
- Heritable arrhythmias or increased risk for torsade de pointes with class I or III
- Prior LA catheter ablation with the intention of treating AF
- Prior surgical interventions for AF such as the MAZE procedure
- Prior AV nodal ablation
- Patients with other arrhythmias requiring ablative therapy
- Contraindication to appropriate anti-coagulation therapy
- Renal failure requiring dialysis
- Medical conditions limiting expected survival to <1 year
- Women of childbearing potential (unless post-menopausal or surgically sterile)
- Participation in any other clinical mortality trial (Participation in other
non-mortality trials should be reviewed with the clinical trial management center)
- Unable to give informed consent
- NOTE- Prior ablation of the cavo-tricuspid isthmus alone is not an exclusion if
the patient develops subsequent recurrent AF. Planned atrial flutter ablation in
combination with the left atrial ablation is not an exclusion.
Ages Eligible for Study
18 Years - 90 Years
Genders Eligible for Study