Early rhythm control effectively and safely reduces cardiovascular events in patients with recently diagnosed atrial fibrillation and stroke risk factors, with and without chronic kidney disease.
RCT (n=2,789)
Does early rhythm control reduce cardiovascular events in patients with recently diagnosed atrial fibrillation and chronic kidney disease?
Early rhythm control safely and effectively reduces cardiovascular events in patients with recently diagnosed atrial fibrillation, including those with chronic kidney disease.
BACKGROUND: Atrial fibrillation (AF) increases cardiovascular risk in patients with chronic kidney disease (CKD). The safety and efficacy of early rhythm control (ERC) in patients with CKD is not fully established. OBJECTIVES: This predefined secondary analysis of the EAST-AFNET 4 trial assessed the effectiveness and safety of ERC in patients with CKD defined by estimated glomerular filtration rate (GFR). METHODS: EAST-AFNET 4 randomized patients with recently diagnosed AF and comorbidities to ERC or usual care (UC). Key outcomes were analyzed by Kidney Disease Improving Global Outcomes defined CKD groups. The primary efficacy outcome combined cardiovascular death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome. The safety outcome combined death, stroke, and serious rhythm control-related adverse events. Recurrent AF was a secondary outcome. RESULTS: Baseline creatinine was available in 2,742 of 2,789 (98.3%) patients. In this study, 23% had CKD (GFR: <60 mL/min/1.73 m CONCLUSION: ERC effectively and safely reduces cardiovascular events in patients with recently diagnosed AF and stroke risk factors with and without CKD. (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST); NCT01288352).
Schenker et al. (2026) conducted an RCT in Atrial fibrillation and chronic kidney disease (n=2,789). Early rhythm control vs. Usual care was evaluated on Cardiovascular death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome. Early rhythm control effectively and safely reduces cardiovascular events in patients with recently diagnosed atrial fibrillation and stroke risk factors, with and without chronic kidney disease.