A separate report of this study details that there was no significant difference in a composite endpoint of death, disabling stroke, serious bleeding or cardiac arrest) for ablation vs medical therapy.
A related editorial discusses this research. It states that although this study is the largest trial to date, it is still conceivable that catheter ablation may have more modest benefits on morbidity and mortality than were able to be detected even in a trial of this size. The mortality rate in the medication treatment group (5.3% at 4 years) was much lower than what was expected based on historical controls (12.0% at 3 years), and the incidence of disabling stroke over 4 years was exceedingly low (0.7%) in the current era of anticoagulation and guideline-based management of AF. Overall, this is excellent news for patients with AF, but also results in the need for a much larger sample of patients than that enrolled in in this study to be able to detect benefits on mortality and stroke.
Moving forward, shared decision making between the cardiologist and the patient is critical in determining treatment. This study provides a wealth of additional data regarding the comparative benefits and risks of catheter ablation vs drug therapy to inform this process. This approach may be well positioned to occur in comprehensive AF management centers that offer the full range of anticoagulation options, antiarrhythmic drug therapy, and percutaneous and surgical procedures, coupled with lifestyle modification, such as weight loss, that may further augment the success of ablation, medical therapies, or both. Thus, this trial provides essential information to optimize the care of patients with AF in a very patient-centric way.