When implemented early on, rhythm control therapy utilizing arrhythmic drugs or atrial fibrillation (AFib) ablation decreases cardiovascular events in patients with heart failure, according to new data published in Circulation.
Using data from the previously completed EAST–AFNET 4 trial, researchers focused on nearly 800 patients who presented with signs of heart failure. While 442 of those patients had heart failure with preserved ejection fraction (HFpEF), 211 had heart failure with mid-range ejection fraction (HFmEF) and the remaining patients had heart failure with reduced ejection fraction (HFrEF). The mean patient age was 71 years old, and 62.4% were men.
All early rhythm control therapy, whether performed using medication or AFib ablation, was carried out following clinical guidelines. Overall, the team found that this approach was associated with consistent improvements in left ventricular function, symptoms and the patient's quality of life.
“This prespecified sub-analysis of the randomized EAST-AFNET 4 trial demonstrates that systematic, early rhythm control therapy using antiarrhythmic drugs and AFib ablation is safe and reduces cardiovascular outcomes in patients with AFib and heart failure compared with the current strategy of delayed, symptom-directed rhythm control,” wrote lead author Andreas Rillig, MD, a specialist at University Medical Center Hamburg–Eppendorf in Germany, and colleagues.
Rillig and colleagues also found that patients with preserved left ventricular ejection fraction had a decreased risk for the study's first primary outcome (cardiovascular death, stroke or hospitalization for worsening of heart failure or for acute coronary syndrome) compared to patients with reduced left ventricular ejection fraction.
“Clinical benefit is observed across the spectrum of heart failure subtypes, suggesting that restoring and maintaining sinus rhythm via rhythm control therapy conveys the clinical benefit," the group wrote. "In the view of the authors, all patients with signs or symptoms of heart failure should be considered for rhythm control therapy within a year of being diagnosed with atrial fibrillation."
The entire study can be found here.