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Is there a mortality benefit of atrial fibrillation ablation?

Catheter ablation (CA) of atrial fibrillation (AF) has dramatically increased in frequency in recent years.1 While early randomized clinical trials (RCTs) of rhythm control for AF using anti-arrhythmic drugs did not show a mortality benefit compared to rate control strategies,2, 3 more recent trials that included CA or medical therapy (MT) for rhythm control have challenged this notion by showing improved clinical outcomes including mortality with rhythm control.4, 5 The largest RCT of AF ablation to date, the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, compared CA to rate or rhythm control with MT (most had rhythm control) in more than 2000 patients, and reported numerically fewer outcome events including total mortality or the composite of death, stroke, bleeding or cardiac arrest with CA; however, the results were not statistically significant by intention-to-treat analysis.6.