Early rhythm control therapy improves outcomes in patients with atrial fibrillation

Date:
August 31, 2020
Source:
European Society of Cardiology
Summary:
Patients with newly diagnosed atrial fibrillation benefit from
early rhythm control therapy, according to new results.



FULL STORY ========================================================================== Patients with newly diagnosed atrial fibrillation benefit from 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 therapy is typically delayed unless patients have
persistent symptoms on otherwise effective rate control. The EAST-AFNET 4
trial investigated whether rhythm control therapy -- with antiarrhythmic
drugs or ablation -- delivered soon after diagnosis improves outcomes.

"The risk of severe cardiovascular complications and death in patients
with atrial fibrillation is highest in the first year after diagnosis, suggesting that early therapy could be most beneficial," said principal investigator Professor Paulus Kirchhof of the University Heart and
Vascular Centre UKE Hamburg, Germany and University of Birmingham,
UK. "Furthermore, atrial fibrillation causes atrial damage within a
few weeks of disease onset. Early rhythm control therapy could reduce
or prevent this damage, making it more effective." A total of 2,789
patients in the first year of atrial fibrillation diagnosis and with at
least two cardiovascular conditions were enrolled from 135 sites in 11 countries during 2011 to 2016. Patients were randomised 1:1 to early
rhythm control therapy or usual care, stratified by sites. Patients
in both groups received treatment for cardiovascular conditions, anticoagulation, and rate control according to guidelines.

Patients in the early rhythm control group received antiarrhythmic drugs
or catheter ablation (chosen by the local study teams). Rhythm control
therapy was escalated when recurrent atrial fibrillation was documented clinically or by ECG, including monitoring with patient-operated ECG
devices.

Patients in the usual care group were initially managed with rate control.

Rhythm control therapy was only used to mitigate severe atrial
fibrillation- related symptoms despite optimal rate control, following
current guidelines.

The first primary outcome was a composite of cardiovascular death, stroke, worsening heart failure, and acute coronary syndrome. The second primary outcome was nights spent in hospital per year. The primary safety outcome
was a composite of stroke, all-cause death, and serious adverse events
caused by rhythm control therapy.

During a median follow-up of 5.1 years, the first primary outcome occurred
in 249 patients on early therapy and in 316 patients receiving usual care.

Adjusting for the group-sequential design of the trial, it occurred
less often in patients on early rhythm control (hazard ratio [HR] 0.79; confidence interval [CI] 0.67-0.94; p=0.005). The absolute risk reduction
with early rhythm control was 1.1% per year.

The clinical benefit of early rhythm control was consistent across
subgroups, including asymptomatic patients and patients without heart
failure. All components of the primary outcome occurred numerically less
often in patients randomised to early therapy, and cardiovascular death
and stroke were significantly reduced compared to usual care.

Regarding the second primary outcome, there was no difference in nights
spent in hospital between groups (early therapy 5.8+/-21.9 days/year;
usual care 5.1+/-15.5 days/year; p=0.226).

The primary safety outcome did not differ between groups (early therapy
231 events; usual care 223 events). Complications of rhythm control
therapy were more common in patients on early therapy, but occurred infrequently, in line with other recent rhythm control trials.

Professor Kirchhof said: "Rhythm control therapy initiated soon after
diagnosis of atrial fibrillation reduces cardiovascular complications
without increasing time spent in hospital and without safety
concerns. These results have the potential to completely change clinical practice towards rhythm control therapy early after the diagnosis of
atrial fibrillation."

========================================================================== Story Source: Materials provided by European_Society_of_Cardiology. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Paulus Kirchhof, A. John Camm, Andreas Goette, Axel Brandes, Lars
Eckardt, Arif Elvan, Thomas Fetsch, Isabelle C. van Gelder, Doreen
Haase, Laurent M. Haegeli, Frank Hamann, Hein Heidbu"chel, Gerhard
Hindricks, Josef Kautzner, Karl-Heinz Kuck, Lluis Mont, G. Andre
Ng, Jerzy Rekosz, Norbert Schoen, Ulrich Schotten, Anna Suling,
Jens Taggeselle, Sakis Themistoclakis, Eik Vettorazzi, Panos
Vardas, Karl Wegscheider, Stephan Willems, Harry J.G.M. Crijns,
Gu"nter Breithardt. Early Rhythm-Control Therapy in Patients with
Atrial Fibrillation. New England Journal of Medicine, 2020; DOI:
10.1056/NEJMoa2019422 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200831112340.htm

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