ESC 2020 | Atrial Fibrillation and Rhythm Control: A Matter of Time?

Early rhythm control therapy in patients recently diagnosed with atrial fibrillation reduces the risk of cardiovascular events compared against the usual treatment of frequency control. 

ESC 2020 | Fibrilación auricular y control del ritmo ¿Una cuestión de tiempo?

These data come from the EAST-AFNET 4 trial recently presented at ESC 2020, simultaneously published in NEJM.

These data suggest that we should offer patients early rhythm control therapy to prevent future cardiovascular complications.

Prior studies, such as the AFFIRM, had not been able to identify the benefits of early rhythm control against ventricular response control therapy in the prevention of hard events. 

The EAST-AFNET 4 randomized 2789 patients to early rhythm control (with drugs and/or ablation) vs. standard treatment (ventricular response control).


Read also: Can Aspirin Use Be Interrupted After Angioplasty?


In the control group, the drugs most often used were flecainide followed by amiodarone. Ablation was used in 8% initially but reached nearly 20% after 2 years. 

The trial was stopped after mean 5.1-year followup after the interim analyzis confirmed efficacy in the rhythm control arm.  Primary efficacy end point (composite of cardiovascular death, stroke and hospitalization for cardiac failure or cardiac event) was reduced 20% in relative terms (HR 0.79; CI 95% 0.66 to 0.94; p=0.005). This equals 3.9 every 100 patients vs. 5 every 100 patients. All primary end point components showed the same trend when analyzed separately. 

Safety end points also resulted similar in both arms, even though initially they were more frequent in the rhythm control arm, which was expected of a study involving an invasive procedure (with potential complications) with ablation.

east-afnet-4-full

Original Title: Early rhythm-control therapy in patients with atrial fibrillation.

Reference: P. Kirchhof et al. New Engl J Med. 2020; Epub ahead of print y presentado en el congreso ESC 2020.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Ultrathin vs Thin-Strut Stents in PCI Patients at High Bleeding Risk

Several in vivo studies have shown that ultrathin stents present lower thrombogenic risk vs. thin-strut stents, which reflects in lower rates of target lesion...

Should We Withdraw Anticoagulation Before TAVR?

Approximately one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have atrial fibrillation and are on oral anticoagulant (OAC) therapy. This creates a complex...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....