Clients with recently detected atrial fibrillation take advantage of early rhythm control therapy, according to results of the EAST-AFNET 4 trial presented in a Hot Line session today at ESC Congress 2020.
Rhythm control treatment is typically postponed unless clients have consistent signs on otherwise efficient rate control. The EAST-AFNET 4 trial examined whether rhythm control therapy– with antiarrhythmic drugs or ablation– delivered not long after diagnosis improves results.
” The risk of serious cardiovascular complications and death in clients with atrial fibrillation is greatest in the first year after medical diagnosis, recommending that early therapy could be most useful,” stated primary investigator Professor Paulus Kirchhof of the University Heart and Vascular Centre UKE Hamburg, Germany and University of Birmingham, UK. “Additionally, atrial fibrillation causes atrial damage within a couple of weeks of disease onset. Early rhythm control treatment could decrease or prevent this damage, making it more reliable.”
Clients were randomised 1:1 to early rhythm control therapy or normal care, stratified by sites. Clients in both groups received treatment for cardiovascular conditions, anticoagulation, and rate control according to standards.
Patients in the early rhythm control group received antiarrhythmic drugs or catheter ablation (chosen by the regional research study groups). Rhythm control therapy was escalated when reoccurring atrial fibrillation was recorded scientifically or by ECG, including monitoring with patient-operated ECG devices.
Patients in the normal care group were at first managed with rate control. Rhythm control treatment was just utilized to reduce extreme atrial fibrillation-related signs despite ideal rate control, following current standards.
The primary safety outcome was a composite of stroke, all-cause death, and serious unfavorable events triggered by rhythm control treatment.
During an average follow-up of 5.1 years, the very first primary outcome occurred in 249 clients on early therapy and in 316 clients getting normal care. Adjusting for the group-sequential style of the trial, it took place less typically in clients on early rhythm control (danger ratio [HR] 0.79; self-confidence interval [CI] 0.67 -0.94; p= 0.005). The outright danger reduction with early rhythm control was 1.1% annually.
The clinical benefit of early rhythm control corresponded throughout subgroups, including asymptomatic clients and clients without heart failure. All elements of the primary outcome happened numerically less often in clients randomised to early treatment, and cardiovascular death and stroke were considerably lowered compared to usual care.
Concerning the second main result, there was no difference in nights spent in medical facility between groups (early therapy 5.8 ±219 days/year; normal care 5.1 ±155 days/year; p= 0.226).
The main security result did not vary in between groups (early treatment 231 events; normal care 223 events). Issues of rhythm control therapy were more typical in patients on early therapy, however occurred occasionally, in line with other current rhythm control trials.
Professor Kirchhof stated: “Rhythm control therapy initiated right after diagnosis of atrial fibrillation decreases cardiovascular complications without increasing time invested in medical facility and without safety concerns. These outcomes have the prospective to completely change medical practice towards rhythm control treatment early after the medical diagnosis of atrial fibrillation.”