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Stabilizing the heart rhythm early in all types of atrial fibrillation (Study EAST – AFNET 4)

Patients with atrial fibrillation are particularly at risk in the first year after diagnosis and can suffer a stroke, for example. | © BillionPhotos.com - stock.adobe.com

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Patients with atrial fibrillation should start therapy that controls the heart rhythm as early as possible after diagnosis: This applies to different types of atrial fibrillation, as a sub-study of the EAST-AFNET-4 study has now shown. Patients with atrial fibrillation diagnosed for the first time, patients with seizure-like (paroxysmal) and patients with persistent atrial fibrillation were examined.

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In the first year after diagnosis, patients with atrial fibrillation are at a particularly high risk of serious complications, which can result in a stroke, heart attack or heart failure. In the worst case, the patient dies. As early as the summer of 2020, the EAST-AFNET-4 study showed that the risk of strokes and severe consequential damage decreases if therapy that stabilizes the heart rhythm is started early. Since the antiarrhythmics that are used have considerable side effects, they have been used rather sparingly in recent years.

Sub-studies confirm the result of the main study: early rhythm maintenance is an advantage

A new sub-study presented at the American Heart Association (AHA) convention in Boston on November 14, 2021, shows that early rhythm control can improve patient outcomes - regardless of the type of atrial fibrillation. Previously, two further sub-studies had already confirmed that patients who do not have typical symptoms for atrial fibrillation and patients with cardiac insufficiency and recently diagnosed atrial fibrillation also benefit from early rhythm maintenance therapy. All three sub-studies thus confirm the result of the main study.

Abnormality in patients with atrial fibrillation diagnosed for the first time

However, there was one abnormality in one of the three patient groups in the current sub-study: patients with atrial fibrillation diagnosed for the first time who received treatment to maintain rhythm early, spent more time in the hospital and were admitted more often for acute coronary syndrome than patients from the comparison group. The study participants from the comparison group also had atrial fibrillation diagnosed for the first time and received the usual treatment. In patients with paroxysmal or persistent atrial fibrillation, this difference between the study groups “early rhythm maintenance” and “usual treatment” did not exist.

The scientists are not yet able to explain this finding completely pathophysiologically. Their conclusion so far is: The decision for early rhythm-preserving treatment should not be made dependent on the type of atrial fibrillation, since the early rhythm maintenance in all types of atrial fibrillation ensured that there were fewer cardiovascular complications.

The EAST-AFNET-4 study was partially financed by the DZHK from 2015 to 2020.

Source: Press Release Kompetenznetz Vorhofflimmern e.V. (AFNET)