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Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial
S. Willems, K. Borof, A. Brandes, G. Breithardt, AJ. Camm, HJGM. Crijns, L. Eckardt, N. Gessler, A. Goette, LM. Haegeli, H. Heidbuchel, J. Kautzner, GA. Ng, RB. Schnabel, A. Suling, L. Szumowski, S. Themistoclakis, P. Vardas, IC. van Gelder, K....
Language English Country Great Britain
Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
Grant support
AA/18/2/34218
British Heart Foundation - United Kingdom
FS/13/43/30324
British Heart Foundation - United Kingdom
PG/18/33/33780
British Heart Foundation - United Kingdom
PG/17/30/32961
British Heart Foundation - United Kingdom
PG/20/22/35093
British Heart Foundation - United Kingdom
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Stroke * diagnosis etiology prevention & control MeSH
- Atrial Fibrillation * drug therapy therapy MeSH
- Catheter Ablation * methods MeSH
- Humans MeSH
- Secondary Prevention MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
AIMS: Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control. METHODS AND RESULTS: This prespecified EAST-AFNET 4 analysis compared the effect of early rhythm control therapy in asymptomatic patients (EHRA score I) to symptomatic patients. Primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome, analyzed in a time-to-event analysis. At baseline, 801/2633 (30.4%) patients were asymptomatic [mean age 71.3 years, 37.5% women, mean CHA2DS2-VASc score 3.4, 169/801 (21.1%) heart failure]. Asymptomatic patients randomized to early rhythm control (395/801) received similar rhythm control therapies compared to symptomatic patients [e.g. AF ablation at 24 months: 75/395 (19.0%) in asymptomatic; 176/910 (19.3%) symptomatic patients, P = 0.672]. Anticoagulation and treatment of concomitant cardiovascular conditions was not different between symptomatic and asymptomatic patients. The primary outcome occurred in 79/395 asymptomatic patients randomized to early rhythm control and in 97/406 patients randomized to usual care (hazard ratio 0.76, 95% confidence interval [0.6; 1.03]), almost identical to symptomatic patients. At 24 months follow-up, change in symptom status was not different between randomized groups (P = 0.19). CONCLUSION: The clinical benefit of early, systematic rhythm control was not different between asymptomatic and symptomatic patients in EAST-AFNET 4. These results call for a shared decision discussing the benefits of rhythm control therapy in all patients with recently diagnosed AF and concomitant cardiovascular conditions (EAST-AFNET 4; ISRCTN04708680; NCT01288352; EudraCT2010-021258-20).
Atrial Fibrillation Network Münster Germany
Department of Cardiology 2 University Hospital Münster Germany
Department of Cardiology Odense University Hospital Denmark
Department of Cardiology Ospedale dell'Angelo Venice Italy
Department of Clinical Research University of Southern Denmark Odense Denmark
Division of Cardiology Medical University Department Kantonsspital Aarau Switzerland
DZHK Partner Site Hamburg Kiel Luebeck Berlin Germany
Heart Sector Hygeia Hospitals Group Athens Greece
Institute for Clinical and Experimental Medicine Prague Czech Republic
Institute of Cardiovascular Sciences University of Birmingham Birmingham UK
Institute of Medical Biometry and Epidemiology University Medical Center Hamburg Eppendorf Germany
St Vincenz Hospital Paderborn Germany
University Hospital Antwerp and Antwerp University Antwerp Belgium
University Hospital Zurich Zurich Switzerland
University of Groningen University Medical Center Groningen Groningen Netherlands
Working Group of Molecular Electrophysiology University Hospital Magdeburg Germany
References provided by Crossref.org
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