Rhythm control therapies were associated with significantly lower mortality compared to no rhythm control (HR 0.86; 95% CI 0.84-0.88), with pulmonary vein isolation showing the greatest benefit.
Cohort (n=199,433)
Yes
Do rhythm control therapies (anti-arrhythmic drugs and catheter ablation) improve survival in patients with new-onset atrial fibrillation compared to no rhythm control?
In a large real-world UK cohort, rhythm control strategies—particularly pulmonary vein isolation—were associated with significantly improved survival in patients with new-onset atrial fibrillation.
Effect estimate: HR 0.86 (95% CI 0.84-0.88)
AIMS: Utilizing real-world UK data, we aimed to understand: (i) whether anti-arrhythmic drugs and catheter ablation are effective in improving the survival of atrial fibrillation (AF) patients and (ii) which rhythm control option produces better results for the whole AF population and for specific groups of patients, stratified by age, sex, and history of heart failure. METHODS AND RESULTS: We identified 199 433 individuals (mean age at diagnosis 75.7 ± 12.7 years; 50.2% women) with new-onset AF diagnosis in nationwide electronic health records linking primary care consultation with hospital data and death registry data from 1998 to 2016. We investigated the survival and causes of death of new-onset AF patients receiving vs. not-receiving rhythm control therapies. During a median follow-up of 2.7 (0.7-6.0) years, we observed a significantly lower mortality in patients receiving rhythm control multivariate-adjusted hazard ratio (HR) = 0.86, 95% confidence interval (CI) 0.84-0.88. Pulmonary vein isolation was associated with a two-third significant mortality reduction compared with no rhythm control (HR = 0.36, 95% CI 0.28-0.48), flecainide with 50% reduction (HR = 0.52, 95% CI 0.48-0.57), and propafenone and sotalol with reduction by a third (HR = 0.63, 95% CI 0.50-0.81, 0.71, 95% CI 0.68-0.74, respectively). Amiodarone showed no survival benefit in individuals <70 years (HR = 0.99, 95% CI 0.97-1.02). Otherwise, the effect of rhythm control on survival did not differ by age, sex, nor history of heart failure. CONCLUSION: Among individuals with new-onset AF, favourable survival was observed for patients receiving rhythm control treatment. Among different rhythm control strategies, pulmonary vein isolation showed the most pronounced survival benefit.
Chung et al. (Thu,) conducted a cohort in new-onset atrial fibrillation (n=199,433). Rhythm control therapies (anti-arrhythmic drugs and catheter ablation) vs. No rhythm control was evaluated on mortality (HR 0.86, 95% CI 0.84-0.88). Rhythm control therapies were associated with significantly lower mortality compared to no rhythm control (HR 0.86; 95% CI 0.84-0.88), with pulmonary vein isolation showing the greatest benefit.