Conference Roundup

Early rhythm-control in AFib linked to lower risk of CV outcomes

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In patients with early atrial fibrillation and cardiovascular conditions, early rhythm-control therapy was associated with a lower risk of cardiovascular outcomes, according to a study published in the New England Journal of Medicine and presented at the virtual European Society of Cardiology (ESC) Congress 2020.

In the EAST-AFNET 4 trial, 2789 patients with early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions were randomized to receive early rhythm control, including use of antiarrhythmic drugs or atrial fibrillation ablation after randomization) or usual care, which limited rhythm control for 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 and the second primary outcome was the number of nights spent in the hospital per year.

The trial was stopped after a median of 5.1 years in favor of efficacy.

A first-primary-outcome event was recorded in 249 patients utilizing early rhythm control and 316 patients undergoing usual care.

The mean number of nights spent in the hospital and 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% and 1.4% of the patients assigned to early rhythm control and usual care, respectively.

Kirchhof P, Camm J, Goette A, et al. Early rhythm-control therapy in patients with atrial fibrillation. New Eng J Med. 2020; DOI: 10.1056/NEJMoa2019422.