Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry

Proietti, Marco; Vitolo, Marco; Harrison, Stephanie L; Lane, Deirdre A.; Fauchier, Laurent; Marin, Francísco; Näbauer, Michael; Potpara, Tatjana; Dan, Gheorghe‐Andrei; Boriani, Giuseppe; Lip, Gregory Y.H.; Investigators, Esc-Ehra Eorp-Af Long-Term General Registry

doi:10.1007/s00392-021-01914-y

Cited by 31 publications

(28 citation statements)

References 39 publications

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“…This may contribute to explain why in a proportion of patients in part similar to EAST AF patients, the choice of strategy in our daily practice was in favor of rhythm control only in less than 20% of cases (data not shown). While the current results of the EAST AF may provide a guide for decision making in appropriately selected patients, a recent analysis from the EORP-AF registry showed that the use of an early rhythm control strategy was not independently associated with a lower rate of major adverse events and associated with a higher use of health care resources [44].…”

Section: Discussionmentioning

confidence: 83%

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

et al. 2021

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The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] was recently proposed to characterize AF patients. In this post hoc analysis we evaluated the agreement between the therapeutic strategy (rate or rhythm control, respectively), as suggested by the 4S-AF scheme, and the actual strategy followed in a patients cohort. Outcomes of interest were as follows: all-cause death, a composite of all-cause death/any thromboembolism/acute coronary syndrome, and a composite of all-cause death, any thrombotic/ischemic event, and major bleeding (net clinical outcome). We enrolled 615 patients: 60.5% male, median age 74 [interquartile range (IQR) 67-80] years; median CHA 2 DS 2 VASc 4 and median HAS-BLED 2. The 4S-AF score would have suggested a rhythm-control strategy in 351 (57.1%) patients while a rate control in 264 (42.9%). The strategy adopted was concordant with the 4S-AF suggestions in 342 (55.6%) cases, and non-concordant in 273 (44.4%). After a median follow-up of 941 days (IQR 365-1282), 113 (18.4%) patients died, 158 (25.7%) had an event of the composite endpoint. On adjusted Cox regression analysis, when 4S-AF score suggested rate control, disagreement with that suggestion was not associated with a worse outcome. When 4S-AF indicated rhythm control, disagreement was associated with a higher risk of all-cause death (HR 7.59; 95% CI 1.65-35.01), and of the composite outcome (HR 2.69; 95% CI 1.19-6.06). The 4S-AF scheme is a useful tool to comprehensively evaluate AF patients and aid the decision-making process. Disagreement with the rhythm control suggestion of the 4S-AF scheme was associated with adverse clinical outcomes.

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Section: Discussionmentioning

confidence: 83%

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

et al. 2021

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“…Importantly, no difference in the primary outcome between early rhythm control and "no rhythm control patients" adherent to the ABC pathway was evident. 28 Therefore, whether the better outcomes of patients assigned to rhythm control in the EAST-AFNET 4 trial were solely due to "early" intervention or because of more regular and structured follow-up was unclear. Our study was performed based on data acquired from the routine daily care with less structured management protocols, and our findings may provide complimentary "real-world" data to support the generalizability of the results of the EAST-AFNET 4 trial into daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

et al. 2022

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Background: In EAST-AFNET 4 trial, early rhythm control was associated with better clinical outcomes for patients with atrial fibrillation (AF). However, whether the better outcomes of patients assigned to rhythm control were solely due to “early” intervention or because of more regular and structured follow up was unclear. Objective: To investigate whether the findings of EAST trial are applicable to the ‘real world’ clinical setting, where a less structured management protocol is operated. Methods: From 2001 to 2016, 301,064 newly-diagnosed AF patients were identified from Taiwan National Health Insurance Research Database. Among these patients, 62,649 AF patients receiving antiarrhythmic drugs or catheter ablation within 1 year after AF being diagnosed were categorized as the early rhythm control group, and the remaining 238,415 patients were defined as usual care group. Risk of clinical events were compared. Results: Compared to usual care, early rhythm control was associated with a lower adjusted risk of ischemic stroke(aHR 0.771; p<0.001), heart failure(aHR 0.851; p<0.001), acute myocardial infarction(aHR 0.915; p<0.001), mortality(aHR 0.794; p<0.001) and composite adverse events(aHR 0.823; p<0.001). Compared to usual care, the lower risks of ischemic stroke(aHR 0.746), heart failure(aHR 0.819), mortality(aHR 0.777) and composite adverse events(aHR 0.802) associated with early rhythm control were even more evident when performed early (<3months)(pint<0.001). Principal results were generally consistent for majority of subgroups studied and among the cohort after propensity matching. Conclusions: Early rhythm control, especially when performed earlier (<3months), was associated with a lower risk of adverse events than usual care among patients with early AF.

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“…This is in line with current recommendation of not considering AF ablation as a last-resort therapeutic strategy, but rather to propose it before the development of atrial dilatation and atrial cardiomyopathy [ 45 , 46 , 47 , 48 ], which imply a reduced effectiveness of the intervention. Recent data on AF ablation [ 12 , 49 , 50 ] and more general data from EAST AF trial indicate that the success of rhythm control strategies is markedly influenced by the time from AF clinical detection [ 51 , 52 , 53 ]. It will be matter of additional investigation to assess the influence of asymptomatic AF episodes, which could be present in a substantial number of patients, with no differences in the impact on hard clinical outcomes, such as stroke [ 54 , 55 , 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation

Boriani¹,

Iacopino²,

Arena³

et al. 2022

JCDD

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The aim of this research was to evaluate if patients with chronic kidney disease (CKD) and mild or mild to moderate depression of renal function have an increased risk of atrial fibrillation (AF) recurrences after cryoballoon (CB) ablation. We performed a retrospective analysis of AF patients undergoing pulmonary vein isolation (PVI) by CB. The cohort was divided according to the KDIGO CKD-EPI classification into a (1) normal, (2) mildly decreased, or (3) mild to moderate reduction in estimated glomerular filtration rate (eGFR). Freedom from AF recurrences was the primary endpoint. A total of 1971 patients were included (60 ± 10 years, 29.0% females, 73.6% paroxysmal AF) in the study. Acute success and complication rates were 99.2% and 3.7%, respectively, with no significant differences among the three groups. After a follow-up of 24 months, AF recurrences were higher in the mildly and mild to moderate CKD groups compared to the normal kidney function group (23.4% vs. 28.3% vs. 33.5%, p < 0.05). Mild to moderate CKD was an independent predictor of AF recurrences after the blanking period (hazard ratio:1.38, 95% CI 1.02–1.86, p = 0.037). In conclusion, a multicenter analysis of AF patients treated with cryoablation revealed mild to moderate reductions in renal functions were associated with a higher risk of AF recurrences. Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in eGFR.

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Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry

Cited by 31 publications

References 39 publications

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation

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