EAST - AFNET 4 for patients

Detection, anticoagulation and early treatment improves quality of life for patients with AF.

Patients with newly diagnosed atrial fibrillation (AF) benefit from early rhythm control therapy, according to results of recent research published at the European Society of Cardiology Congress 2020.  The research study is called EAST – AFNET 4.

Heart rhythm control treatment with antiarrhythmic drugs to reduce the irregular heart rhythm and/or AF ablation treatment reduced the risk of death, AF-related stroke and hospitalization for worsening heart failure or acute coronary syndrome in 2789 patients with early AF and cardiovascular risk factors compared to usual care over a 5-year follow-up time.

Principal investigator Professor Paulus Kirchhof of the University Heart and Vascular Centre UKE Hamburg, Germany and the University of Birmingham, UK, states: “Rhythm control treatment initiated soon after diagnosis of atrial fibrillation reduced cardiovascular outcomes in patients with early AF and cardiovascular conditions without increasing time spent in hospital and without safety concerns. These results have the potential to completely change clinical practice towards rhythm control therapy early after the diagnosis of atrial fibrillation.”

According to guideline recommendations, rhythm control treatment is typically delayed unless patients have persistent symptoms on otherwise effective rate control. The EAST – AFNET 4 trial investigated whether rhythm control treatment– with antiarrhythmic drugs or ablation – delivered soon after AF diagnosis improves outcomes.
“Even on oral anticoagulation and optimal rate control, cardiovascular death, stroke, and heart failure are common in patients with atrial fibrillation, especially in those with other cardiovascular conditions” said Professor John Camm, St. George’s University of London, UK, and EAST executive Steering Committee member.

“The risk of severe cardiovascular outcomes and death in patients with atrial fibrillation is highest in the first year after diagnosis, suggesting that early rhythm control could be most beneficial,” Professor Kirchhof said. “Furthermore, atrial fibrillation causes atrial damage of the heart within a few weeks of disease onset. Early rhythm control treatment could reduce or prevent this damage, making it more effective.”

A total of 2789 patients with early AF (diagnosed less than a year ago) and at least two cardiovascular conditions were enrolled by 135 sites in 11 countries during 2011 to 2016. Patients were randomised 1:1 to early rhythm control therapy or usual care, stratified by sites. Patients in both groups received guideline-recommended treatment for underlying cardiovascular conditions, anticoagulation therapy, and rate control.
 

After almost a decade of successful teamwork, the results of the EAST-AFNET 4 trial are available. We answer if early rhythm control is able to prevent complications for patients with atrial fibrillation. 

The results of the EAST-AFNET 4 trial were presented at the congress of European Society of Cardiology (ESC). A video with the most important results is presented by Prof. Paulus Kirchhof (English only): 

AFNET YouTube Channel

Further information you can find here (English only).

Furthermore here's the press release for the EAST-AFNET 4 trial (German only)

Jensen M, Suling A, Metzner A, Schnabel R, Borof K, Goette A, Haeusler KG, Zapf A, Wegscheider K, Fabritz L, Diener H-C, Thomalla G, Kirchhof P. Early rhythm-control therapy for atrial fibrillation in patients with a history of stroke: a subgroup analysis of the EAST- AFNET 4 trial. Lancet Neurol 2023; 22: 45–54. DOI: 10.1016/PIIS1474-4422(22)00436-7

Eckardt L, Sehner S, Suling A, Borof K, Breithardt G, Crijns HJGM, Goette A, Wegscheider K, Zapf A, Metzner A, Kirchhof P. Attaining sinus rhythm mediates improved outcome with early rhythm control therapy of atrial fibrillation: the EAST – AFNET 4 trial. European Heart Journal, 29 August 2022. doi: 10.1093/eurheartj/ehac471

Rillig A, Borof K, Breithardt G, Camm AJ, Crijns HJGM, Goette A, Kuck KH, Metzner A, Vardas P, Vettorazzi E, Wegscheider K, Zapf A, Kirchhof P. Early Rhythm Control in Patients With Atrial Fibrillation and High Comorbidity Burden. Circulation 2022. Epub 15 August 2022. . doi: 10.1161/CIRCULATIONAHA.122.060274

Goette A, Borof K, Breithardt G, Camm AJ, Crijns HJG, Kuck KH, Wegscheider K, Kirchhof P. Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy. J Am Coll Cardiol. 2022;80(4):283-295 

Metzner A, Suling A, Brandes A,  Breithardt G, Camm AJ, Crijns HJGM, Eckardt L, Elvan A, Goette A, Haegeli L, Heidbuchel H, Kautzner J, Kuck KH, Mont L, NG A, Szumowski L, Themistoclakis S, van Gelder I, Vardas P, Wegscheider K, Willems S, Kirchhof P. Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial. Europace (2021) 00, 1–13, 02 September 2021. doi:10.1093/europace/euab200

Willems S, Borof K, Brandes A, Breithardt G, Camm AJ, Crijns HJGM, Eckardt L, Gessler N, Goette A, Haegeli L, Heidbuchel H, Kautzner J, NG A, Schnabel R, Suling A,  Szumowski L, Themistoclakis S, Vardas P, van Gelder I, Wegscheider K, Kirchhof P. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. European Heart Journal, 27 August 2021. doi:10.1093/eurheartj/ehab593

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. Epub 30 July 2021. [published online ahead of print]. doi: 10.1161/CIRCULATIONAHA.121.056323

McNamara DA, Chopra R, Ganantra RB, Suzuki T, Kirchhof P, Wegscheider K, Breithardt G. Letter to the editor: EAST-AFNET 4 Early rhythm control therapy in patients with atrial fibrillation. New England Journal of Medicine. Epub 04 February 2021. doi: 10:1056/NEJMc2032433

Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, Fetsch T, van Gelder IC, Haase D, Haegeli LM, Hamann F, Heidbüchel H, Hindricks G, Kautzner J, Kuck K-H, Mont L, Ng GA, Rekosz J, Schön N, Schotten U, Suling A, Taggeselle J, Themistoclakis S, Vettorazzi E, Vardas P, Wegscheider K, Willems S, Crijns HJGM, Breithardt G, for the EAST–AFNET 4 trial investigators. Early rhythm control therapy in patients with atrial fibrillation. New England Journal of Medicine. Epub 29 Aug 2020. doi: 10.1056/NEJMoa2019422

Haegeli L, Aliot E, Brandes A, Eckardt L, Elvan A, Gulizia M, Heidbuchel H, Kautzner J, Mont L, Morgan J, Ng A, Szumowski L, Themistoclakis S, Van Gelder IC, Willems S, Kirchhof P. The EAST study: redefining the role of rhythmcontrol therapy in atrial fibrillation: EAST, the Early treatment of Atrial fibrillation for Stroke prevention Trial. Eur Heart J. 2015 Feb 1;36(5):255-6. doi: 10.1093/eurheartj/ehu476. Epub 2015 Jan 30.

Kirchhof P, Breithardt G, Camm AJ, Crijns H, Kuck K-H, Vardas P, Wegscheider K. Improving outcomes in patients with atrial fibrillation: Rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial. Am Heart J 2013; 166(3):442-8. doi:10.1016/j.ahj.2013.05.015

Van Gelder IC, Haegeli LM, Brandes A, Heidbuchel H, Aliot E, Kautzner J, Szumowski L, Mont L, Morgan J, Willems S, Themistoclakis S, Gulizia M, Elvan A, Smit MD, Kirchhof P. Rationale and current perspective for early rhythm control therapy in atrial fibrillation. Europace 2011;13:1517-25. DOI:10.1093/europace/eur192.