Why early rhythm control therapy is so important for atrial fibrillation patients

Rhythm control therapy benefits patients with newly diagnosed atrial fibrillation (AFib), according to results of the EAST-AFNET 4 trial. The impact was consistent across the board, with even asymptomatic patients and those without heart failure seeing improved outcomes.   

The study, presented at ESC Congress 2020 and published in the New England Journal of Medicine, examined how early rhythm control therapy impacted more than 2,700 AFib patients who had been diagnosed within the last year.

“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 author Paulus Kirchhof, MD, of the University Medical Center Hamburg-Eppendorf in Germany, said in a statement. “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.”

Patients were recruited for the trial from eleven different countries from 2011 to 2016, and each one either underwent early rhythm control therapy or usual care. While patients in the early rhythm control group were given antiarrhythmic medications or catheter ablation, patients in the usual care group were managed with rate control.

During a median follow-up period of more than five years, the study’s first primary outcome—a composite of cardiovascular death, stroke, worsening heart failure and acute coronary syndrome—occurred in 249 patients from the early rhythm control therapy group and 316 patients from the usual care group. The absolute risk reduction was estimated to be 1.1% per year.

Looking at the study’s second primary outcome—nights spent in the hospital per year—the authors noticed no significant difference.

In addition, the authors noted, the benefits of early rhythm control were “consistent across subgroups, including asymptomatic patients and patients without heart failure.”

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

The full study from the New England Journal of Medicine can be read here.

ESC Congress 2020 is completely digital due to the ongoing COVID-19 pandemic. More information from the European Society of Cardiology is available here.