Projects per year
Abstract
AIMS: Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control.
METHODS AND RESULTS: This prespecified EAST-AFNET 4 analysis compared the effect of early rhythm control therapy in asymptomatic patients (EHRA score I) to symptomatic patients. Primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome, analyzed in a time-to-event analysis. At baseline, 801/2633 (30.4%) patients were asymptomatic [mean age 71.3 years, 37.5% women, mean CHA2DS2-VASc score 3.4, 169/801 (21.1%) heart failure]. Asymptomatic patients randomized to early rhythm control (395/801) received similar rhythm control therapies compared to symptomatic patients [e.g. AF ablation at 24 months: 75/395 (19.0%) in asymptomatic; 176/910 (19.3%) symptomatic patients, P = 0.672]. Anticoagulation and treatment of concomitant cardiovascular conditions was not different between symptomatic and asymptomatic patients. The primary outcome occurred in 79/395 asymptomatic patients randomized to early rhythm control and in 97/406 patients randomized to usual care (hazard ratio 0.76, 95% confidence interval [0.6; 1.03]), almost identical to symptomatic patients. At 24 months follow-up, change in symptom status was not different between randomized groups (P = 0.19).
CONCLUSION: The clinical benefit of early, systematic rhythm control was not different between asymptomatic and symptomatic patients in EAST-AFNET 4. These results call for a shared decision discussing the benefits of rhythm control therapy in all patients with recently diagnosed AF and concomitant cardiovascular conditions (EAST-AFNET 4; ISRCTN04708680; NCT01288352; EudraCT2010-021258-20).
Original language | English |
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Article number | ehab593 |
Pages (from-to) | 1219–1230 |
Number of pages | 12 |
Journal | European Heart Journal |
Volume | 43 |
Issue number | 12 |
Early online date | 27 Aug 2021 |
DOIs | |
Publication status | Published - 21 Mar 2022 |
Bibliographical note
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.Keywords
- Atrial fibrillation
- Symptoms
- Rhythm control
- Ablation
- Antiarrhythmic drugs
- Clinical trial
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Dive into the research topics of 'Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial'. Together they form a unique fingerprint.Projects
- 3 Finished
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BHF Research Accelerator Award
Bicknell, R. (Co-Investigator), Watson, S. (Co-Investigator), Rainger, E. (Co-Investigator), Senis, Y. (Co-Investigator), Fabritz, L. (Co-Investigator) & Kirchhof, P. (Principal Investigator)
1/04/19 → 30/09/24
Project: Research
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Impact of chronic intermittent hypoxia on atrial resting membrane potential and Na 1.5 channel function: A new mechanism for causing atrial fibrillation
Kirchhof, P. (Principal Investigator) & Holmes, A. (Co-Investigator)
1/10/17 → 18/07/21
Project: Research
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Understanding the function of PITX2 in the adult left atrium
Kirchhof, P. (Principal Investigator) & Fabritz, L. (Co-Investigator)
4/11/13 → 3/11/18
Project: Research