The EAST-AFNET 4 trial: Early rhythm control therapy for atrial fibrillation [Classics Series]

This study summary is an excerpt from the book 2 Minute Medicine’s The Classics in Medicine: Summaries of the Landmark Trials

1. This study found that in patients with early atrial fibrillation, a composite outcome of cardiovascular death, hospitalization, or stroke was significantly lower in those treated with rhythm control (3.9%) as compared to controls (5.0%).

2. Duration of hospitalization did not vary significantly between groups.

Original Date of Publication: October 2020

Study Rundown: The present study compared long-term outcomes of rhythm control versus therapy as usual in patients diagnosed with early atrial fibrillation. The rhythm control group had a significantly lower rate of first-primary outcome events, including a composite of cardiovascular death, cardiac hospitalization, or stroke. Conversely, duration of hospital stays as well as left ventricular and cognitive function did not differ between the study groups. The major limitation of this study was an open trial design, although assessment of primary outcomes was blinded to reduce bias. This was the first trial to demonstrate that early implementation of rhythm control for atrial fibrillation is associated with long-term reduction in cardiovascular complications and stroke without increasing time admitted to hospital.

Click to read the study in NEJM

In-Depth [randomized control trial]: This study randomized patients who were within a year of atrial fibrillation diagnosis to either rhythm control (n = 1395) or treatment as usual (n = 1394) for a median follow-up time of 5.1 years. Adverse events and outcomes were adjudicated by a blinded end-point review committee. The primary outcome was a composite of first-cardiovascular hospitalization, cardiovascular mortality, and stroke which was significantly lower in the rhythm control group (HR 0.79; 96%CI 0.66-0.94). There was no significant difference between groups in left ventricular function, cognitive function atrial fibrillation-related symptoms, or duration of hospitalization. Quality of life as measured by EQ-5D score also did not differ between groups.

Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. The . New England Journal of Medicine. 2020 Oct 1;383(14):1305–16.

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