Early Rhythm-Control Therapy in Patients with Atrial Fibrillation
Abstract
This multicenter randomized controlled trial (EAST-AFNET 4) tested whether initiating rhythm-control therapy early in atrial fibrillation (AF) defined as diagnosis within one year reduces adverse cardiovascular outcomes in patients with coexisting cardiovascular conditions. A total of 2789 patients were randomly assigned to either early rhythm-control therapy (using antiarrhythmic drugs or AF ablation) or usual care with rate control alone unless symptoms necessitated rhythm intervention. Over a median 5.1-year follow-up, early rhythm control significantly reduced the composite primary outcome (cardiovascular death, stroke, or hospitalization for heart failure or acute coronary syndrome) compared to usual care (HR: 0.79; 96% CI: 0.66–0.94; P=0.005). Stroke rates were notably lower, and most patients maintained sinus rhythm without worsening left ventricular function or increased hospitalization burden. Adverse events related to rhythm control were infrequent and acceptable. The findings suggest that early rhythm control offers superior protection against cardiovascular events without compromising safety or symptom management.
Keywords:
atrial fibrillation
rhythm control
antiarrhythmic drugs
ablation
cardiovascular outcomes
stroke prevention
EAST-AFNET 4
early intervention
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