Early rhythm control reduces CV complications in low-risk AF patients

Use of early rhythm control therapy for atrial fibrillation (AF) in preventing adverse cardiovascular (CV) outcomes also benefits patients with low stroke risk in routine clinical practice, suggests a recent study.

A total of 54,216 AF patients having early rhythm control (antiarrhythmic drugs or ablation) or rate control therapy initiated within 1 year of AF diagnosis were considered for this population-based cohort study. Participants were identified using the nationwide claims database of the Korean National Health Insurance Service.

Using propensity overlap weighting, the investigators compared the effect of early rhythm control on the primary composite outcome of CV death, ischaemic stroke, hospitalization for heart failure, or myocardial infarction between eligible and ineligible patients for Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4; CHA₂DS₂-VASc score, approximately 0 to 1).

Of the identified participants, 37,557 (69.3 percent, median age 70 years, median CHA₂DS₂-VASc score, 4) met the eligibility criteria. In this population, early rhythm control correlated with a lower risk for the primary composite outcome relative to rate control (hazard ratio [HR], 0.86, 95 percent confidence interval [CI], 0.81‒0.92).

Likewise, early rhythm control was associated with a lower risk for the primary outcome (HR, 0.81, 95 percent CI, 0.66‒0.98) among the 16,659 low-risk patients (30.7 percent) who did not meet the eligibility criteria (median age 54 years, median CHA₂DS₂-VASc score, 1).

Regardless of trial eligibility, no significant differences were noted in safety outcomes between the rhythm and rate control strategies.

The study, however, was limited by residual confounding.

“Rhythm control is associated with lower risk for adverse CV outcomes compared with usual care among patients recently diagnosed with AF with a CHA₂DS₂-VASc score of approximately 2 or greater in EAST-AFNET 4,” the investigators said.