What is the clinical evidence from this study?

Study design: RCT. Population: Atrial fibrillation and heart failure. Intervention: Early rhythm control therapy (antiarrhythmic drugs or catheter ablation) vs. Usual care. Primary outcome: 2 primary outcomes of the trial.

July 30, 2021Open Access

Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure

Key Result

Early rhythm control therapy improved the composite outcome of death or hospitalization for worsening of heart failure in patients with atrial fibrillation and heart failure.

Study Design

Type

RCT

Structured PICO

Does systematic, early rhythm control therapy improve clinical outcomes in patients with atrial fibrillation and heart failure?

Population

Patients with atrial fibrillation and heart failure, defined as heart failure symptoms New York Heart Association II to III or left ventricular ejection fraction [LVEF] <50%.

Intervention

Systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) initiated within 1 year of diagnosing atrial fibrillation.

Comparator

Usual care (allowing rhythm control therapy to improve symptoms).

Outcome

The 2 primary outcomes of the trial (not explicitly named in the abstract).composite

Early rhythm control therapy conveys clinical benefit when initiated within 1 year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure.

Abstract

BACKGROUND: Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction. METHODS: This prespecified subanalysis of the randomized EAST-AFNET4 trial (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) assessed the effect of systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) compared with usual care (allowing rhythm control therapy to improve symptoms) on the 2 primary outcomes of the trial and on selected secondary outcomes in patients with heart failure, defined as heart failure symptoms New York Heart Association II to III or left ventricular ejection fraction LVEF <50%. RESULTS: =0.43). ERC also improved the composite outcome of death or hospitalization for worsening of heart failure. CONCLUSIONS: Rhythm control therapy conveys clinical benefit when initiated within 1 year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01288352. URL: http://www.controlled-trials.com; Unique identifier: ISRCTN04708680. URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2010-021258-20.