Components of AF management and early rhythm-control therapy in EAST-AFNET 4

The EAST-AFNET 4 study showed that an early, structured rhythm control therapy based on antiarrhythmic drugs and catheter ablation can prevent atrial fibrillation (AF)-related complications when compared with usual care. This approach is feasible and clinical benefit can be achieved without many additional visits, using regionally different treatment choices.

Dr Andreas Metzner (University Heart & Vascular Center Hamburg, Germany) presented an analysis of the EAST-AFNET 4 study (NCT01288352) focussing on components of AF management and early rhythm control in patients with AF. The EAST-AFNET 4 study evaluated the effects of early rhythm control in patients with AF on the composite primary endpoint of cardiovascular death, stroke, hospitalisation for heart failure or acute coronary syndrome. Participants (n=2,789) were randomised into 2 study arms: one receiving usual care (n=1,394) and the other receiving early rhythm-control therapy (n=1,395). Mean follow-up time was 5.1 years/patient.

Over 90% of patients received oral anticoagulation therapy, with more than 54% of patients receiving a direct oral anticoagulant (DOAC). There was no difference in the treatment of heart failure, hypertension, or diabetes. Rate control therapy was used in 4 out of 5 patients in both study arms. The number of in-person follow-up visits was low in both study arms: 1.94 visits/patients in controls versus 2.13 visits/patient in the treatment arm, with the higher number in the second study population being derived from more frequent visits after randomisation to adjust rhythm control therapy.

In usual care, rhythm control remained the exception. Antiarrhythmic drug (AAD) therapy in the treatment arm was initially given to 84% of patients, with 45% of patients still receiving AAD after 2 years. Random group was by far the strongest predictor of receiving therapy at any time.

Results showed a 21% risk reduction for cardiovascular death, stroke, hospitalisation for heart failure or acute coronary syndrome in patients receiving early rhythm control.

Dr Metzner concluded: “systematic and early rhythm control results in clinical benefit when added to evidence-based oral anticoagulation, therapy of concomitant cardiovascular conditions, and rate control therapy. The clinical benefit of early rhythm control was achieved without many additional visits and with regionally different treatment choices within guideline recommendations.”

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   1. Metzner A. Components of AF management and early rhythm control in patients with atrial fibrillation: a detailed analysis of the EAST-AFNET 4 dataset. 2021 EHRA Congress, 23-25 April.

 



Posted on 24 April, 202116 June, 2021