EAST - AFNET 4 for patients


Early treatment of atrial fibrillation for stroke prevention trial (EAST)




Information for patients

Nummer of patients

Planned: 2745

Enrolled: 2789

End of follow-up: 06 March 2020

Countries involved

Belgium, Czech Republic, Denmark, France, Germany, Great britain, Italy, Netherlands, Poland, Spanien, Switzerland


The EAST - AFNET 4 trial evaluated whether early treatment of atrial fibrillation can prevent strokes, heart failure or heart attack like pain.

The trial compared treatment strategies approved and recommended for therapy of atrial fibrillation. The new approach in EAST - AFNET 4 consisted of the earlier than usual onset of the treatment. This was to show whether earlier treatment leads to an improved outcome of the cardiac arrhythmia.

Patient enrollment for the EAST - AFNET 4 trial has been completed. The follow-up visits were completed in spring of 2020.

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.

The trial has been completed.

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: (Link ist extern)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. (Link ist extern)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. (Link ist extern)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. (Link ist extern)Europace 2011;13:1517-25. DOI:10.1093/europace/eur192.



Kompetenznetz Vorhofflimmern e.V., Münster, Deutschland


Coordinating Investigators

Prof. Paulus Kirchhof, Hamburg, DE
Prof. Günter Breithardt, Münster, DE
Prof. Harry Crijns, Maastricht, NL
Prof. John Camm, London, UK


ClinicalTrials.gov:  NCT01288352


EudraCT: 2010-021258-20

Website: www.easttrial.org