Results from the EAST-AFNET Trial were presented at the European Society of Cardiology

Early rhythm control treatment for afib is safe and effective and reduces cardiovascular complications

September 1, 2020

  • Summary: EAST-AFNET Late-Breaking Clinical Trial showed that early afib treatment with rhythm control is safe and effective.
  • Reading time: 3–4 minutes

Results from EAST-AFNET (Early treatment of Atrial fibrillation for Stroke prevention Trial) were reported at the 2020 European Society of Cardiology Congress: The Digital Experience, which was held this week in Amsterdam. This trial was presented as a Hot Line session (late-breaking clinical trial).

Typically, newly-diagnosed afib patients are treated with rate control medications first. If that doesn’t work, then rhythm control medications may be used.

We know that irreversible damage to the heart from afib starts early, so this trial explored starting rhythm control treatments early.

In this trial, 2,789 people at 135 sites in 11 countries were randomized, with half receiving Usual Care and half receiving Early Rhythm Control treatments. Those could be either rhythm control medications or catheter ablation.

Those receiving rhythm control medications in the Early Rhythm Control group received mostly flecainide, amiodarone, or dronedarone; a small percentage received propafenone or other anti-arrhythmic drugs. Initially, about 8% received catheter ablations, but by two years into the trial, almost 20% had.

In the Usual Care group, by two years into the trial, about 14% had started receiving rhythm control treatment, with half of those receiving catheter ablation.

After a median follow-up of 5.1 years, the rate of events in the early rhythm control group was 3.9% per year, whereas it was 5% per year for the usual care group, for an absolute risk reduction of 1.1% per year. Those events included cardiovascular death, stroke, or hospitalization for heart failure or acute coronary syndrome (conditions such as a heart attack). Each category of events was higher in the usual care group than in the early rhythm control group.

In looking at the data from subgroups, those who especially seemed to benefit from early rhythm control were those at the highest obesity levels, those with a history of stroke, and those with heart failure who had ejection fractions of less than 35%. More research is needed to determine if these effects appear in other trials.

As expected, there were more (though infrequent) adverse events related to the medications in the early rhythm control group, but safety overall was comparable in both groups.    

The conclusion was that early rhythm control is safe and effective and that it reduces cardiovascular complications that can be associated with afib.

These findings may change treatment practices for afib patients, with rhythm control being used earlier and more often in the treatment for afib. Early treatment with catheter ablation aligns with the new ESC guidelines, which state that catheter ablation may be used as a first-line treatment in selected patients.

The trial was published in The New England Journal of Medicine simultaneously to the presentation at ESC.

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