B-po05-069 sex-specific quality of life outcomes of ablation versus drug therapy for af: insights from cabana

Atrial fibrillation (AF) is associated with decline in quality of life (QOL). The magnitude of this decline and the response to catheter ablation (CA) versus drug based treatment varies between men and women. To assess sex-specific changes in QOL following CA-based versus drug-based AF treatment. In CABANA, 2204 patients were randomized to CA or drug based AF treatment. QOL as measured by the Mayo AF-Specific Symptom Inventory (MAFSI) and Atrial Fibrillation Effect on Quality of Life (AFEQT) were prespecified major secondary endpoints, and compared with drug therapy, CA led to significant QOL improvement at 12 months. This analysis compares QOL outcomes by sex in intention to treat groups. Women comprised 37% of both treatment groups and tended to be older with more paroxysmal versus persistent AF and greater functional limitation compared with men. At baseline, women had numerically worse QOL than men by MAFSI frequency score and AFEQT (Figure). There was significant and clinically meaningful QOL benefit of CA over drug therapy at 12 months in women as measured by MAFSI frequency score (adjusted mean difference CA minus drug therapy -2.1 [95% CI -1.2- -3.1]) and AFEQT (6.0 95% CI 3.2-8.9). A similar pattern was seen in men. The QOL benefit of CA over drug based treatment in the first 12 months was attenuated over time largely due to improvements in QOL in the drug-based group, and this effect was greater in women than men (Figure). Women had numerically worse QOL at baseline than men. In the treatment of AF, CA-based therapy is superior to drug-based therapy for improving QOL in women and men.