Early rhythm control therapy bests rate control for lowering CV complications in most AF patients

Researchers have found in a

cohort study of patients with atrial fibrillation (AF) and low risk for stroke that early rhythm control therapy was linked to a low risk of cardiovascular complications including ischemic stroke, hospitalization for heart failure, or myocardial infarction and death compared to rate control therapy.

The findings have been published in Annals of Internal Medicine.

AF is associated with increased mortality and morbidity from stroke and congestive heart failure as well as impaired quality of life. Therapies like rate control are important to the management of AF and typically improves symptoms.

Previous studies comparing rhythm and rate control have not demonstrated significant differences in effects on mortality and stroke, but the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) recently showed that rhythm control therapy was associated with lower risk for adverse cardiovascular outcomes compared with usual care among patients diagnosed with AF within the previous year.

Researchers from Yonsei and CHA University College of Medicine studied 54,216 patients with AF having early rhythm or rate control therapy that was initiated within the first year of diagnosis to investigate whether EAST-AFNET 4 results can be generalized to patients with low stroke risk.

The authors report that almost 70 percent of study participants were eligible for EAST-AFNET 4. That data showed that the protective associations between early rhythm control and cardiovascular outcomes were similar for the eligible patients as well as ineligible low-risk patients who participated in the study.

There were no significant differences in safety outcomes between rhythm control and rate control in either group, suggesting no need for tradeoffs sacrificing safety for better cardiovascular outcomes. These findings suggest that the effect of early rhythm control in improving outcomes was prominent in low-risk patients and supports initiatives for active consideration of rhythm control among all patients recently diagnosed with AF in clinical practice.

Reference:

Daehoon Kim, Pil-Sung Yang, Seng Chan You, et al; Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients: A Nationwide Propensity Score–Weighted Study. Ann Intern Med. [Epub 6 September 2022]. doi:10.7326/M21-4798