Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

. 2020 Oct 01 ; 383 (14) : 1305-1316. [epub] 20200829

Jazyk angličtina Země Spojené státy americké Médium print-electronic

Typ dokumentu srovnávací studie, časopisecké články, multicentrická studie, randomizované kontrolované studie, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid32865375

Grantová podpora
PG/18/33/33780 British Heart Foundation - United Kingdom

BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk. METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated. RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups. CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Citace poskytuje Crossref.org

Nejnovějších 20 citací...

Zobrazit více v
Medvik | PubMed

Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation

. 2025 Jan ; 36 (1) : 256-265. [epub] 20241126

Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial

. 2024 Sep 03 ; 13 (17) : e036429. [epub] 20240827

Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study

. 2024 Jul ; 30 (7) : 2020-2029. [epub] 20240708

Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

. 2024 May 21 ; 45 (19) : 1733-1737.

Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h

. 2024 Mar 07 ; 45 (10) : 837-849.

Rhythm versus rate control in patients with newly diagnosed atrial fibrillation - Observations from the GARFIELD-AF registry

. 2023 Dec ; 49 () : 101302. [epub] 20231116

The influence of atrial high-rate episodes on stroke and cardiovascular death: an update

. 2023 Jul 04 ; 25 (7) : .

AFA-Recur: an ESC EORP AFA-LT registry machine-learning web calculator predicting atrial fibrillation recurrence after ablation

. 2023 Feb 08 ; 25 (1) : 92-100.

Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care

. 2022 Dec 15 ; 9 (1) : 47-57.

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)

. 2022 Sep 01 ; 24 (8) : 1256-1266.

Catheter ablation versus antiarrhythmic drugs with risk factor modification for treatment of atrial fibrillation: a protocol of a randomised controlled trial (PRAGUE-25 trial)

. 2022 Jun 15 ; 12 (6) : e056522. [epub] 20220615

Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial

. 2022 Apr 05 ; 24 (4) : 552-564.

Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

. 2022 Mar 21 ; 43 (12) : 1219-1230.

Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: observational study using prospectively collected registry data

. 2021 Oct 27 ; 375 () : e066450. [epub] 20211027

Zobrazit více v PubMed

ISRCTN
ISRCTN04708680

ClinicalTrials.gov
NCT01288352

EudraCT
2010-021258-20

Najít záznam

Citační ukazatele

Nahrávání dat ...

    Možnosti archivace