Key result
Prior rhythm control fails to reduce major events in AF patients with stable CAD.
Why the study?
Rhythm control therapy improves quality of life and prognosis in AF, but characteristics and clinical outcomes in patients with stable CAD were evaluated.
Does a history of rhythm control therapy improve clinical outcomes in patients with atrial fibrillation and stable coronary artery disease?
Cohort (n=2,215)
Does a history of rhythm control therapy improve clinical outcomes in patients with atrial fibrillation and stable coronary artery disease?
Effect estimate: adjusted HR 0.75 (95% CI 0.37-1.51)
p-value: p=0.43
In patients with AF and stable CAD, a history of rhythm control therapy was not associated with improved clinical outcomes after adjusting for baseline characteristics.
Prior rhythm control not associated with better outcomes in AF with stable CAD; leaves open whether randomized trials show benefit.
Background Rhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy. Methods We analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not. Results At baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37–1.51, p = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43–1.30, p = 0.30 in the combination therapy group). Conclusions The initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.
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Wakatsuki et al. (2025) conducted a cohort in Atrial fibrillation with stable coronary artery disease (n=2,215). History of rhythm control therapy vs. No history of rhythm control therapy was evaluated on Composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death (adjusted HR 0.75, 95% CI 0.37-1.51, p=0.43). Prior rhythm control therapy did not significantly reduce stroke, systemic embolism, MI, unstable angina, or death in AF patients with stable CAD (adjusted HR 0.75; 95% CI 0.37-1.51; p=0.43).
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