Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

Stephan Willems; Katrin Borof; Axel Brandes; Günter Breithardt; A John Camm; Harry J G M Crijns; Lars Eckardt; Nele Gessler; Andreas Goette; Laurent M Haegeli; Hein Heidbuchel; Josef Kautzner; G André Ng; Renate B Schnabel; Anna Suling; Lukasz Szumowski; Sakis Themistoclakis; Panos Vardas; Isabelle C van Gelder; Karl Wegscheider; Paulus Kirchhof

doi:10.1093/eurheartj/ehab593

Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

Stephan Willems
, Katrin Borof
, Axel Brandes
, Günter Breithardt
, A John Camm
, Harry J G M Crijns
, Lars Eckardt
, Nele Gessler
, Andreas Goette
, Laurent M Haegeli
, Hein Heidbuchel
, Josef Kautzner
, G André Ng
, Renate B Schnabel
, Anna Suling
, Lukasz Szumowski
, Sakis Themistoclakis
, Panos Vardas
, Isabelle C van Gelder
, Karl Wegscheider

Paulus Kirchhof^*

^*Kontaktforfatter

KI, OUH, Forskningsenhed for Kardiologi (Odense)

Semmelweis University Campus Hamburg
University Medical Center Hamburg-Eppendorf
Atrial Fibrillation NETwork (AFNET)
St George's, University of London
Maastricht University Medical Center+
Antwerp University Hospital
Institute for Clinical and Experimental Medicine
University Hospitals of Leicester NHS Trust
German Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, München, Germany.
Medical Division of Cardinal Stefan Wyszynski University in Warsaw
Cardiology Department
HYGEIA
University of Groningen
University Hospital Zurich
St Vincenz Krankenhaus, Paderborn, Germany.
University Hospital Magdeburg

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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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).

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	43
Udgave nummer	12
Sider (fra-til)	1219-1230
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehab593
Status	Udgivet - 21. mar. 2022

Bibliografisk note

Dokumenter og links

10.1093/eurheartj/ehab593Licens: CC BY

Open Access VersionForlagets udgivne version, 1,03 MBLicens: CC BY

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

Willems, S., Borof, K., Brandes, A., Breithardt, G., Camm, A. J., Crijns, H. J. G. M., Eckardt, L., Gessler, N., Goette, A., Haegeli, L. M., Heidbuchel, H., Kautzner, J., Ng, G. A., Schnabel, R. B., Suling, A., Szumowski, L., Themistoclakis, S., Vardas, P., van Gelder, I. C., ... Kirchhof, P. (2022). Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. European Heart Journal, 43(12), 1219-1230. https://doi.org/10.1093/eurheartj/ehab593

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title = "Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial",

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).",

keywords = "Aged, Anti-Arrhythmia Agents/therapeutic use, Atrial Fibrillation/drug therapy, Catheter Ablation/methods, Female, Humans, Male, Secondary Prevention, Stroke/diagnosis",

author = "Stephan Willems and Katrin Borof and Axel Brandes and G{\"u}nter Breithardt and Camm, \{A John\} and Crijns, \{Harry J G M\} and Lars Eckardt and Nele Gessler and Andreas Goette and Haegeli, \{Laurent M\} and Hein Heidbuchel and Josef Kautzner and Ng, \{G Andr{\'e}\} and Schnabel, \{Renate B\} and Anna Suling and Lukasz Szumowski and Sakis Themistoclakis and Panos Vardas and \{van Gelder\}, \{Isabelle C\} and Karl Wegscheider and Paulus Kirchhof",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2022",

month = mar,

day = "21",

doi = "10.1093/eurheartj/ehab593",

language = "English",

volume = "43",

pages = "1219--1230",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "12",

}

Willems, S, Borof, K, Brandes, A, Breithardt, G, Camm, AJ, Crijns, HJGM, Eckardt, L, Gessler, N, Goette, A, Haegeli, LM, Heidbuchel, H, Kautzner, J, Ng, GA, Schnabel, RB, Suling, A, Szumowski, L, Themistoclakis, S, Vardas, P, van Gelder, IC, Wegscheider, K & Kirchhof, P 2022, 'Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial', European Heart Journal, bind 43, nr. 12, s. 1219-1230. https://doi.org/10.1093/eurheartj/ehab593

TY - JOUR

T1 - Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms

T2 - the EAST-AFNET 4 trial

AU - Willems, Stephan

AU - Borof, Katrin

AU - Brandes, Axel

AU - Breithardt, Günter

AU - Camm, A John

AU - Crijns, Harry J G M

AU - Eckardt, Lars

AU - Gessler, Nele

AU - Goette, Andreas

AU - Haegeli, Laurent M

AU - Heidbuchel, Hein

AU - Kautzner, Josef

AU - Ng, G André

AU - Schnabel, Renate B

AU - Suling, Anna

AU - Szumowski, Lukasz

AU - Themistoclakis, Sakis

AU - Vardas, Panos

AU - van Gelder, Isabelle C

AU - Wegscheider, Karl

AU - Kirchhof, Paulus

PY - 2022/3/21

Y1 - 2022/3/21

N2 - 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).

AB - 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).

KW - Aged

KW - Anti-Arrhythmia Agents/therapeutic use

KW - Atrial Fibrillation/drug therapy

KW - Catheter Ablation/methods

KW - Female

KW - Humans

KW - Male

KW - Secondary Prevention

KW - Stroke/diagnosis

U2 - 10.1093/eurheartj/ehab593

DO - 10.1093/eurheartj/ehab593

M3 - Journal article

C2 - 34447995

SN - 0195-668X

VL - 43

SP - 1219

EP - 1230

JO - European Heart Journal

JF - European Heart Journal

IS - 12

ER -

Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

Abstract

Bibliografisk note

Dokumenter og links

SDU link

Fingeraftryk

Citationsformater