Rhythm control therapy beneficial in patients with HF newly
In patients diagnosed with atrial fibrillation for less than 1 year, those with HF benefited from rhythm control therapy compared with the usual care, according to new data from the EAST-AFNET 4 trial.

In the main results of EAST-AFNET 4, early rhythm control therapy with antiarrhythmic drugs and/or catheter ablation within 1 year of AF diagnosis in patients with CV conditions reduced risk for CV events compared with usual care. A subanalysis of patients from the EAST-AFNET 4 cohort with HF was presented at Heart Rhythm 2021 and simultaneously published in Circulation.

The cohort included 798 patients (mean age, 71 years; 38% women), most of whom had HF with preserved ejection fraction, who were followed for a median of 5.1 years.

During the study period, the primary outcome of CV death, stroke, hospitalization for worsening HF or hospitalization for ACS occurred less frequently in the rhythm control group than in the usual care group (5.7 per 100 patient-years vs. 7.9 per 100 patient-years), they said, noting that the results did not vary by HF status.

There was no difference between the groups in the primary safety outcome of death, stroke or serious events related to rhythm control therapy (rhythm control, 17.9%; usual care, 21.6%), according to the researchers.

The secondary outcome similar to that used in CASTLE-AF, death or hospitalization for worsening HF, occurred less often in the early rhythm control group, researchers found.

Left ventricular ejection fraction improved in both groups, “mainly in the patients with reduced or midrange left ventricular ejection fraction,” authors said.

“Rhythm control therapy conveys clinical benefit when initiated within 1 year of diagnosis of atrial fibrillation in patients with signs and symptoms of heart failure,” researchers said. “The clinical benefit is across the spectrum of heart failure subtypes, which is important. This study supports a treatment strategy of rhythm control therapy with antiarrhythmic drugs or AF ablation within a year of AF diagnosis in patients with signs or symptoms of heart failure.”

Source: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.121.056323