EP News: Allied Professionals

Abstract

Kirchhof et al (N Engl J Med 2020;383:1305, PMID 32865375) in the randomized Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4) sought to determine whether rhythm control therapy improved outcomes as compared with usual care in patients with early atrial fibrillation (AF). Early AF is defined as AF initially diagnosed within past 12 months. Inclusion criteria included patients with early AF and age more than 75 years, history of stroke or transient ischemic attack, or any 2 of the following criteria: age >65 years, female sex, hypertension (HTN), diabetes mellitus, heart failure (HF), coronary artery disease, left ventricular hypertrophy, and/or chronic kidney disease. All patients were treated for their underlying conditions, anticoagulated per guidelines, and were on rate control therapy before being randomized to either early rhythm control or usual care. Rhythm control strategies included initiation of antiarrhythmic drugs (AADs), cardioversion, and AF ablation. Patients in the usual care group were continued on rate control therapy with crossover to rhythm control therapy only if continued symptoms in AF despite adequate rate control. There were 2 primary outcomes: the first was a composite of death from cardiovascular causes, stroke, and hospitalization for HF or acute coronary syndrome; and the second was the number of nights in the hospital per year. The primary safety outcome was composite of stroke, death from any cause, and complication of rhythm control therapy.