Rhythm control for ALL patients with early AFib

Rhythm control for ALL patients with early AFib

Please note that this is a shortened version of the article. The full article is available on our online platform Medical Academic.

Systematic and early initiation of rhythm control therapy should be part of the management of all patients with early atrial fibrillation (AFib) who are at risk of concomitant cardiovascular diseases (CVDs).

This should be done in combination with oral anticoagulation and rate control, as well as the treatment of underlying CVDs. The risk of CV complications is increased during the first year after AFib is diagnosed. This is according to Prof Paulus Kirchhof, director of the department of cardiology at the University Heart and Vascular Center Hamburg (Germany), and professor of CV medicine at the Institute of CV Sciences at the University of Birmingham (United Kingdom).

Prof Kirchhof is the lead author of the landmark Early Treatment of AFib for Stroke Prevention Trial (EAST-AFNET 4). He was one of the keynote speakers at the recent virtual Cardiac Arrhythmia Society of Southern Africa 2021 symposium. He provided a brief overview of the findings of the trial, which was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient.

Take-home messages

Early initiation of improved CV outcomes in patient with early AFib and CV conditions without affecting nights spent in hospital

2. As expected, the early rhythm control strategy was associated with more adverse events related to rhythm control therapy but the overall safety of both treatment strategies was comparable

3. These results have the potential to inform the future use of rhythm control therapy, further improving the care of patients with early AFib

4. Systematic and early initiation of rhythm control therapy should be part of the management in all patients with recently diagnosed AFib and concomitant CV conditions in addition to oral anticoagulation, rate control and therapy of concomitant CV conditions.

Whenever you ask yourself if you should initiate anticoagulation therapy in a patient with AFib, you should from now on ask yourself if you need to inititate rhythm control therapy.

Prof Kirchhof concluded that the cardiology community needs to relearn the art of prescribing antiarrhythmic drugs, that has somehow disappeared from medical training curricula. That specialist knowledge needs to be reappreciated and reacquired, he emphasised. SF