Evidence map›Paper›PMID 34238436›Full record

Trial reportJournal of the American College of Cardiology2021

Ablation Versus Drug Therapy for Atrial Fibrillation in Racial and Ethnic Minorities.

Kevin L Thomas, Hussein R Al-Khalidi, Adam P Silverstein, Kristi H Monahan, Tristram D Bahnson, Jeanne E Poole, Daniel B Mark, Douglas L Packer, CABANA Investigators

Registry-linked trialOpen access · greenAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00911508 (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial), which is not on this map. Cited by 24 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 3 pooled it
5.0field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00911508 nacompletednot on this map

Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial

TypeinterventionalSponsorMayo ClinicRan2009 to 2017Enrolled2,204ConditionsAtrial Fibrillation, ArrhythmiaArmsLeft atrial ablation, Rate or Rhythm Control Therapy
3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Guideline
  4. Trial
  5. Review
  6. Review
  7. Role of Transesophageal Echocardiography in Guiding and Evaluating Left Atrial Appendage Occlusion in Patients With Non-Organic Heart Disease.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2025
    Observational
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023
    Review
  14. Review
  15. Article
  16. Article
  17. Article
  18. Review
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  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Kevin L ThomasDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA. Electronic address: kevin.thomas@duke.edu.
Hussein R Al-KhalidiDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Adam P SilversteinDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Kristi H MonahanMayo Clinic-St Mary's Campus, Rochester, Minnesota, USA.
Tristram D BahnsonDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Jeanne E PooleUniversity of Washington Medical Center, Seattle, Washington, USA.
Daniel B MarkDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Douglas L PackerMayo Clinic-St Mary's Campus, Rochester, Minnesota, USA.
CABANA Investigators
Duke University · USMayo Clinic · USUniversity of Washington Medical Center · US

Funding

CABANA-AF TrialU01HL089786 · NHLBI · DUKE UNIVERSITY · PI AL-KHALIDI, HUSSEIN · 2009 to 2014
$10.7M
Catheter Ablation versus Antiarrythmic Drug Therapy for Atrial Fibrilllation TriaU01HL089709 · NHLBI · MAYO CLINIC ROCHESTER · PI PACKER, DOUGLAS L · 2009 to 2014
$4.4M
Cabana Image Analysis LabU01HL089645 · NHLBI · MAYO CLINIC ROCHESTER · PI ROBB, RICHARD A · 2009 to 2014
$1.6M
CABANA EQOL TrialU01HL089907 · NHLBI · DUKE UNIVERSITY · PI MARK, DANIEL B · 2009 to 2014
$1.3M
NHLBI NIH HHS U01 HL089645NHLBI NIH HHS U01 HL089709NHLBI NIH HHS U01 HL089786NHLBI NIH HHS U01 HL089907
6 · The paper itself

Abstract

backgroundRhythm control strategies for atrial fibrillation (AF), including catheter ablation, are substantially underused in racial/ethnic minorities in North America.

objectivesThis study sought to describe outcomes in the CABANA trial as a function of race/ethnicity.

methodsCABANA 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.

resultsOf 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%).

conclusionAmong 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).

Indexed as

AgedAnti-Arrhythmia AgentsAtrial FibrillationCatheter AblationEthnic and Racial MinoritiesFemaleHumansMaleMiddle AgedNorth AmericaAnti-Arrhythmia Agentsatrial fibrillationcatheter ablationminority raceoutcomesrandomized trials

Identifiers

PMID34238436
PMCPMC8354144
OpenAlexW3177906120

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.