AIMS: Treatment patterns were compared between randomized groups in EAST-AFNET 4 to assess whether differences in anticoagulation, therapy of concomitant diseases, or intensity of care can explain the clinical benefit achieved with early rhythm control in EAST-AFNET 4. METHODS AND RESULTS: Cardiovascular treatment patterns and number of visits were compared between randomized groups in EAST-AFNET 4. Oral anticoagulation was used in >90% of patients during follow-up without differences between randomized groups. There were no differences in treatment of concomitant conditions between groups. The type of rhythm control varied by country and centre. Over time, antiarrhythmic drugs were given to 1171/1395 (84%) patients in early therapy, and to 202/1394 (14%) in usual care. Atrial fibrillation (AF) ablation was performed in 340/1395 (24%) patients randomized to early therapy, and in 168/1394 (12%) patients randomized to usual care. 97% of rhythm control therapies were within class I and class III recommendations of AF guidelines. Patients randomized to early therapy transmitted 297 166 telemetric electrocardiograms (ECGs) to a core lab. In total, 97 978 abnormal ECGs were sent to study sites. The resulting difference between study visits was low (0.06 visits/patient/year), with slightly more visits in early therapy (usual care 0.39 visits/patient/year; early rhythm control 0.45 visits/patient/year, P < 0.001), mainly due to visits for symptomatic AF recurrences or recurrent AF on telemetric ECGs. CONCLUSION: The clinical benefit of early, systematic rhythm control therapy was achieved using variable treatment patterns of antiarrhythmic drugs and AF ablation, applied within guideline recommendations.

Arrhythmia Center of the National Institute of Cardiology Medical Division of Cardinal Stefan Wyszynski University in Warsaw Warsaw Poland

Atrial Fibrillation Network Münster Germany

Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St George's University of London London UK

Cardiovascular Sciences University of Birmingham Birmingham UK

Centro Investigación Biomedica en Red Cardiovascular Madrid Spain

Department of Cardiology 2 University Hospital Münster Münster Germany

Department of Cardiology Asklepios Klinik St Georg Hamburg Germany

Department of Cardiology Maastricht University Medical Center and Cardiovascular Research Institute Maastricht Maastricht Netherlands

Department of Cardiology Odense University Hospital Odense Denmark

Department of Cardiology Ospedale dell'Angelo Venice Italy

Department of Cardiology University Heart and Vascular Center University Medical Center Hamburg Eppendorf Martinistraße 52 20246 Hamburg Germany

Department of Cardiovascular Sciences University of Leicester National Institute for Health Research Leicester Biomedical Research Centre Glenfield Hospital Leicester UK

Department of Clinical Research University of Southern Denmark Odense Denmark

Division of Cardiology Medical University Department Kantonsspital Aarau Aarau Switzerland

German Center of Cardiovascular Research Partner Site Hamburg Lübeck Kiel Hamburg Germany

Heart Sector Hygeia Hospitals Group Athens Greece

Institute for Clinical and Experimental Medicine Prague Czech Republic

Institute of Medical Biometry and Epidemiology University Medical Center Hamburg Eppendorf Hamburg Germany

Isala Hospital and Diagram Research Zwolle The Netherlands

LANS Cardio Hamburg Germany

St Vincenz Hospital Paderborn Germany

University Hospital Antwerp and Antwerp University Antwerp Belgium

University Hospital Zurich Zurich Switzerland

University of Barcelona and Institut de Recerca Biomèdica August Pi Sunyer Barcelona Spain

University of Groningen University Medical Center Groningen Groningen Netherlands

Working Group of Molecular Electrophysiology University Hospital Magdeburg Magdeburg Germany

Europace. 2022 Apr 5;24(4):564. doi: 10.1093/europace/euab277. PubMed

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