Early Rhythm Control Shows Benefits for Patients with Atrial Fibrillation: Study

Early rhythm control appears to benefit patients with atrial fibrillation (AFib), results from a new study indicates.

“The risk of severe cardiovascular complications and death in patients with AFib is highest in the first year after diagnosis, suggesting that early therapy could be most beneficial,” lead investigator Professor Paulus Kirchhof of the University Heart and Vascular Centre UKE Hamburg, Germany and University of Birmingham, UK, said in a news release about the study. “Furthermore, AFib causes atrial damage within a few weeks of disease onset. Early rhythm control therapy could reduce or prevent this damage, making it more effective.”

Investigators for the EAST-AFNET 4  international, parallel-group, open, blinded-outcome-assessment trial included 2,789 patients with early AFib (diagnosed a year or less prior to enrollment). Patients were randomly assigned to either early rhythm control or to usual care. Early rhythm control also included treatment with antiarrhythmic drugs or ablation. Usual care consisted of limited rhythm control for the management of AFib symptoms. The primary study outcome of interest was a composite endpoint of death from cardiovascular causes including stroke, hospitalization with worsening heart failure or acute coronary syndrome, with a second primary outcome as the number of nights spent in the hospital per year. The primary safety outcomes included death, stroke, or serious adverse event related to rhythm-control therapy.

According to the paper, the trial was stopped for efficacy after a media follow-up of 5.1 years per patient.  A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control and in 316 patients assigned to usual care (HR=0.79; 96% CI, 0.66 to 0.94; P=0.005). Nights staying in the hospital did not differ significantly between the groups. The authors also reported no difference in safety outcomes between the groups (with rhythm-control-related adverse events occurring in 4.9% of patients in the rhythm control group compared with 1.4% in the usual care group). The authors also reported no significant differences in symptoms and left ventricular function at two years between the groups.

“Rhythm control therapy initiated soon after diagnosis of AFib reduces cardiovascular complications without increasing time spent in hospital and without safety concerns,” Prof. Kirchhof said. “These results have the potential to completely change clinical practice towards rhythm control therapy early after the diagnosis of AFib.”

The study was presented at the Hot Line sessions of ESC Congress 2020 in Sophia Antipolis, France. The manuscript was published simultaneously in the New England Journal of Medicine.