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Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

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Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. / Kirchhof, Paulus; Camm, A John; Goette, Andreas; Brandes, Axel; Eckardt, Lars; Elvan, Arif; Fetsch, Thomas; van Gelder, Isabelle C; Haase, Doreen; Haegeli, Laurent M; Hamann, Frank; Heidbüchel, Hein; Hindricks, Gerhard; Kautzner, Josef; Kuck, Karl-Heinz; Mont, Lluis; Ng, G Andre; Rekosz, Jerzy; Schoen, Norbert; Schotten, Ulrich; Suling, Anna; Taggeselle, Jens; Themistoclakis, Sakis; Vettorazzi, Eik; Vardas, Panos; Wegscheider, Karl; Willems, Stephan; Crijns, Harry J G M; Breithardt, Günter; EAST-AFNET 4 Trial Investigators.

in: NEW ENGL J MED, Jahrgang 383, Nr. 14, 01.10.2020, S. 1305-1316.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

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, Schoen, N, Schotten, U, Suling, A, Taggeselle, J, Themistoclakis, S, Vettorazzi, E, Vardas, P, Wegscheider, K, Willems, S, Crijns, HJGM, Breithardt, G & EAST-AFNET 4 Trial Investigators 2020, 'Early Rhythm-Control Therapy in Patients with Atrial Fibrillation', NEW ENGL J MED, Jg. 383, Nr. 14, S. 1305-1316. https://doi.org/10.1056/NEJMoa2019422

APA

Kirchhof, P., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., van Gelder, I. C., Haase, D., Haegeli, L. M., Hamann, F., Heidbüchel, H., Hindricks, G., Kautzner, J., Kuck, K-H., Mont, L., Ng, G. A., Rekosz, J., Schoen, N., ... EAST-AFNET 4 Trial Investigators (2020). Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. NEW ENGL J MED, 383(14), 1305-1316. https://doi.org/10.1056/NEJMoa2019422

Vancouver

Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. NEW ENGL J MED. 2020 Okt 1;383(14):1305-1316. https://doi.org/10.1056/NEJMoa2019422

Bibtex

@article{d018e67edff84d6793471b84aa01eea2,
title = "Early Rhythm-Control Therapy in Patients with Atrial Fibrillation",
abstract = "BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk.METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated.RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups.CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).",
author = "Paulus Kirchhof and Camm, {A John} and Andreas Goette and Axel Brandes and Lars Eckardt and Arif Elvan and Thomas Fetsch and {van Gelder}, {Isabelle C} and Doreen Haase and Haegeli, {Laurent M} and Frank Hamann and Hein Heidb{\"u}chel and Gerhard Hindricks and Josef Kautzner and Karl-Heinz Kuck and Lluis Mont and Ng, {G Andre} and Jerzy Rekosz and Norbert Schoen and Ulrich Schotten and Anna Suling and Jens Taggeselle and Sakis Themistoclakis and Eik Vettorazzi and Panos Vardas and Karl Wegscheider and Stephan Willems and Crijns, {Harry J G M} and G{\"u}nter Breithardt and {EAST-AFNET 4 Trial Investigators}",
note = "Copyright {\textcopyright} 2020 Massachusetts Medical Society.",
year = "2020",
month = oct,
day = "1",
doi = "10.1056/NEJMoa2019422",
language = "English",
volume = "383",
pages = "1305--1316",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "14",

}

RIS

TY - JOUR

T1 - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

AU - Kirchhof, Paulus

AU - Camm, A John

AU - Goette, Andreas

AU - Brandes, Axel

AU - Eckardt, Lars

AU - Elvan, Arif

AU - Fetsch, Thomas

AU - van Gelder, Isabelle C

AU - Haase, Doreen

AU - Haegeli, Laurent M

AU - Hamann, Frank

AU - Heidbüchel, Hein

AU - Hindricks, Gerhard

AU - Kautzner, Josef

AU - Kuck, Karl-Heinz

AU - Mont, Lluis

AU - Ng, G Andre

AU - Rekosz, Jerzy

AU - Schoen, Norbert

AU - Schotten, Ulrich

AU - Suling, Anna

AU - Taggeselle, Jens

AU - Themistoclakis, Sakis

AU - Vettorazzi, Eik

AU - Vardas, Panos

AU - Wegscheider, Karl

AU - Willems, Stephan

AU - Crijns, Harry J G M

AU - Breithardt, Günter

AU - EAST-AFNET 4 Trial Investigators

N1 - Copyright © 2020 Massachusetts Medical Society.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk.METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated.RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups.CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).

AB - BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk.METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated.RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups.CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).

U2 - 10.1056/NEJMoa2019422

DO - 10.1056/NEJMoa2019422

M3 - SCORING: Journal article

C2 - 32865375

VL - 383

SP - 1305

EP - 1316

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 14

ER -