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Rillig A, Magnussen C, Ozga AK, et al. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation. 2021;144(11):845-858doi: 10.1161/CIRCULATIONAHA.121.056323.
Rillig, A., Magnussen, C., Ozga, A. K., Suling, A., Brandes, A., Breithardt, G., Camm, A. J., Crijns, H. J. G. M., Eckardt, L., Elvan, A., Goette, A., Gulizia, M., Haegeli, L., Heidbuchel, H., Kuck, K. H., Ng, A., Szumowski, L., van Gelder, I., Wegscheider, K., & Kirchhof, P. (2021). Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation, 144(11), 845-858. https://doi.org/10.1161/CIRCULATIONAHA.121.056323
Rillig, Andreas, et al. "Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure." Circulation vol. 144,11 (2021): 845-858. doi: https://doi.org/10.1161/CIRCULATIONAHA.121.056323
Rillig A, Magnussen C, Ozga AK, Suling A, Brandes A, Breithardt G, Camm AJ, Crijns HJGM, Eckardt L, Elvan A, Goette A, Gulizia M, Haegeli L, Heidbuchel H, Kuck KH, Ng A, Szumowski L, van Gelder I, Wegscheider K, Kirchhof P. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation. 2021 Sep 14;144(11):845-858. doi: 10.1161/CIRCULATIONAHA.121.056323. Epub 2021 Jul 30. PMID: 34328366; PMCID: PMC8456351.
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Circulation. 2021 Sep 14;144(11):845-858. doi: 10.1161/CIRCULATIONAHA.121.056323. Epub 2021 Jul 30.

Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure.

Circulation

Andreas Rillig, Christina Magnussen, Ann-Kathrin Ozga, Anna Suling, Axel Brandes, Günter Breithardt, A John Camm, Harry J G M Crijns, Lars Eckardt, Arif Elvan, Andreas Goette, Michele Gulizia, Laurent Haegeli, Hein Heidbuchel, Karl-Heinz Kuck, Andre Ng, Lukasz Szumowski, Isabelle van Gelder, Karl Wegscheider, Paulus Kirchhof

Affiliations

  1. Department of Cardiology, University Heart and Vascular Center (A.R., C.M., P.K.), University Medical Center Hamburg-Eppendorf, Germany.
  2. German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel (A.R., C.M., K.-H.K., K.W., P.K.).
  3. Institute of Medical Biometry and Epidemiology (A.-K.O., A.S., K.W.), University Medical Center Hamburg-Eppendorf, Germany.
  4. Department of Cardiology, Odense University Hospital, Denmark (A.B.).
  5. Department of Clinical Research, University of Southern Denmark, Odense (A.B.).
  6. Atrial Fibrillation Network (AFNET), Münster, Germany (G.B., L.E., A.G., K.-H.K., K.W., P.K.).
  7. Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany (G.B., L.E.).
  8. Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, United Kingdom (A.J.C.).
  9. Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Netherlands (H.J.G.M.C.).
  10. Isala Hospital and Diagram Research, Zwolle, The Netherlands (A.E.).
  11. St. Vincenz Hospital, Paderborn, Germany (A.G.).
  12. Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Germany (A.G.).
  13. Garibaldi-Nesima-Hospital, Catania, Italy (M.G.).
  14. University Hospital Zurich, Zurich, Switzerland (L.H.).
  15. Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland (L.H.).
  16. University Hospital Antwerp and Antwerp University, Belgium (H.H.).
  17. LANS Cardio, Hamburg, Germany (K.-H.K.).
  18. Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (A.N.).
  19. Arrhythmia Center of the National Institute of Cardiology; Medical Division of Cardinal Stefan Wyszynski University in Warsaw, Poland (L.S.).
  20. University of Groningen, University Medical Center Groningen, Netherlands (I.v.G.).
  21. Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (P.K.).

PMID: 34328366 PMCID: PMC8456351 DOI: 10.1161/CIRCULATIONAHA.121.056323

Abstract

BACKGROUND: Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction.

METHODS: This prespecified subanalysis of the randomized EAST-AFNET4 trial (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) assessed the effect of systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) compared with usual care (allowing rhythm control therapy to improve symptoms) on the 2 primary outcomes of the trial and on selected secondary outcomes in patients with heart failure, defined as heart failure symptoms New York Heart Association II to III or left ventricular ejection fraction [LVEF] <50%.

RESULTS: This analysis included 798 patients (300 [37.6%] female, median age 71.0 [64.0, 76.0] years, 785 with known LVEF). The majority of patients (n=442) had heart failure and preserved LVEF (LVEF≥50%; mean LVEF 61±6.3%), the others had heart failure with midrange ejection fraction (n=211; LVEF 40%-49%; mean LVEF 44 ± 2.9%) or heart failure with reduced ejection fraction (n=132; LVEF<40%; mean LVEF 31±5.5%). Over the 5.1-year median follow-up, the composite primary outcome of cardiovascular death, stroke, or hospitalization for worsening of heart failure or for acute coronary syndrome occurred less often in patients randomly assigned to ERC (94/396; 5.7 per 100 patient-years) compared with patients randomly assigned to usual care (130/402; 7.9 per 100 patient-years; hazard ratio, 0.74 [0.56-0.97];

CONCLUSIONS: Rhythm control therapy conveys clinical benefit when initiated within 1 year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01288352. URL: http://www.controlled-trials.com; Unique identifier: ISRCTN04708680. URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2010-021258-20.

Keywords: acute coronary syndrome; anti-arrhythmia agents; atrial fibrillation; atrial fibrillation ablation; controlled clinical trial; death; heart failure; stroke

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