Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

被引：127

作者：

Willems, Stephan ^{[1
,2
,3
]}

Borof, Katrin ^{[4
]}

Brandes, Axel ^{[5
,6
]}

Breithardt, Gunter ^{[3
,7
]}

Camm, A. John ^{[8
]}

Crijns, Harry J. G. M. ^{[9
,10
]}

Eckardt, Lars ^{[3
,7
]}

Gessler, Nele ^{[1
,2
]}

Goette, Andreas ^{[6
,11
,12
]}

Haegeli, Laurent M. ^{[13
,14
]}

Heidbuchel, Hein ^{[15
,16
]}

Kautzner, Josef ^{[17
]}

Ng, G. Andre ^{[18
]}

Schnabel, Renate B. ^{[2
,4
]}

Suling, Anna ^{[19
]}

Szumowski, Lukasz ^{[20
]}

Themistoclakis, Sakis ^{[21
]}

Vardas, Panos ^{[22
]}

van Gelder, Isabelle C. ^{[23
]}

Wegscheider, Karl ^{[2
,3
,17
]}

Kirchhof, Paulus ^{[2
,3
,4
,24
]}

机构：

[1] Semmelweis Univ, Fac Med, Dept Cardiol & Internal Intens Care Med, Asklepios Hosp St Georg, Campus Hamburg, Hamburg, Germany

[2] DZHK German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Luebeck, Berlin, Germany

[3] Atrial Fibrillat Network AFNET, Munster, Germany

[4] Univ Med Ctr Hamburg, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany

[5] Odense Univ Hosp, Dept Cardiol, Odense, Denmark

[6] Univ Southern Denmark, Dept Clin Res, Odense, Denmark

[7] Univ Hosp Munster, Dept Cardiol Electrophysiol 2, Munster, Germany

[8] St Georges Univ London, Mol & Clin Sci Res Inst, Cardiol Clin Acad Grp, London, England

[9] Maastricht Univ, Dept Cardiol, Med Ctr, Maastricht, Netherlands

[10] Cardiovasc Res Inst Maastricht, Maastricht, Netherlands

[11] St Vincenz Hosp, Paderborn, Germany

[12] Univ Hosp Magdeburg, Working Grp Mol Electrophysiol, Magdeburg, Germany

[13] Univ Hosp Zurich, Zurich, Switzerland

[14] Kantonsspital Aarau, Div Cardiol, Med Univ Dept, Aarau, Switzerland

[15] Univ Hosp Antwerp, Antwerp, Belgium

[16] Antwerp Univ, Antwerp, Belgium

[17] Inst Clin & Expt Med, Prague, Czech Republic

[18] Univ Leicester, Glenfield Hosp, Natl Inst Hlth Res Leicester Biomed Res Ctr, Dept Cardiovasc Sci, Leicester, Leics, England

[19] Univ Med Ctr Hamburg, Inst Med Biometry & Epidemiol, Eppendorf, Eppendorf, Germany

[20] Cardinal Stefan Wyszynski Univ Warsaw, Arrhythmia Ctr, Natl Inst Cardiol, Med Div, Warsaw, Poland

[21] Osped Angelo, Dept Cardiol, Venice, Italy

[22] Hygeia Hosp Grp, Heart Sect, Athens, Greece

[23] Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands

[24] Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England

来源：

EUROPEAN HEART JOURNAL | 2022年 / 43卷 / 12期

基金：

欧洲研究理事会; 欧盟地平线“2020”;

关键词：

Atrial fibrillation; Symptoms; Rhythm control; Ablation; Antiarrhythmic drugs; Clinical trial; CATHETER ABLATION; RADIOFREQUENCY ABLATION; OUTCOMES; MANAGEMENT; THERAPY;

D O I：

10.1093/eurheartj/ehab593

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control. Methods and results This prespecified EAST-AFNET 4 analysis compared the effect of early rhythm control therapy in asymptomatic patients (EHRA score I) to symptomatic patients. Primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome, analyzed in a timeto-event analysis. At baseline, 801/2633 (30.4%) patients were asymptomatic [mean age 71.3 years, 37.5% women, mean CHA(2)DS(2)-VASc score 3.4, 169/801 (21.1%) heart failure]. Asymptomatic patients randomized to early rhythm control (395/801) received similar rhythm control therapies compared to symptomatic patients [e.g. AF ablation at 24 months: 75/395 (19.0%) in asymptomatic; 176/910 (19.3%) symptomatic patients, P= 0.672]. Anticoagulation and treatment of concomitant cardiovascular conditions was not different between symptomatic and asymptomatic patients. The primary outcome occurred in 79/395 asymptomatic patients randomized to early rhythm control and in 97/406 patients randomized to usual care (hazard ratio 0.76, 95% confidence interval [0.6; 1.03]), almost identical to symptomatic patients. At 24 months follow-up, change in symptom status was not different between randomized groups (P = 0.19). Conclusion The clinical benefit of early, systematic rhythm control was not different between asymptomatic and symptomatic patients in EAST-AFNET 4. These results call for a shared decision discussing the benefits of rhythm control therapy in all patients with recently diagnosed AF and concomitant cardiovascular conditions (EAST-AFNET 4; ISRCTN04708680; NCT01288352; EudraCT2010-021258-20). [GRAPHICS] .

引用

页码：1219 / 1230

页数：12

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