November 23, 2020

The EAST-AFNET 4 Trial: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

Background: Approximately one in four adults over forty-five years of age will develop atrial fibrillation (AF) during their lifetime. There is a clear association between AF and premature death, ischemic stroke, and cardiovascular events in the first year after atrial fibrillation is diagnosed (“Early atrial fibrillation”). Treatment for AF broadly consists of two categories: rate-control to slow ventricular response rate, and rhythm-control in an attempt to maintain a sinus rhythm. However, there is no systematic evidence that rhythm control treatment improves outcome in atrial fibrillation patients. Observations support that the presence of fibrillation is one of few modifiable factors associated with death in AF patients. Current guidelines for treating AF are largely based on individual factors that are often influenced by impressions of the treating physician. Furthermore, therapy for AF is only indicated in patients with recurrent AF. In summary, the treating physician is left alone in the important therapeutic decision as to whether pursuing sinus rhythm is important in a given patient....Read More