- Question
- Can a rhythm-control strategy started early reduce cardiovascular complications in patients with recently diagnosed atrial fibrillation?
- Design
- International, investigator-initiated, parallel-group, open-label trial with blinded outcome assessment; 2789 patients randomized at 135 centers. It was stopped for efficacy at the third interim analysis after a median follow-up of 5.1 years.
- Population
- Patients with early atrial fibrillation (diagnosed up to 1 year before enrollment; median 36 days since diagnosis) and accompanying cardiovascular conditions.
- Intervention
- Early rhythm control: antiarrhythmic drugs or atrial fibrillation ablation initiated after randomization.
- Control
- Usual care, in which rhythm control was limited to managing symptoms related to atrial fibrillation.
- Primary outcome
- First primary outcome: composite of cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome. Second primary outcome: number of nights spent in hospital per year.
- Results
- The first primary outcome occurred in 249 patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 assigned to usual care (5.0 per 100 person-years) (HR 0.79; 96% CI 0.66 to 0.94; P = 0.005). Nights in hospital did not differ significantly (5.8 ± 21.9 vs. 5.1 ± 15.5 days per year; P = 0.23).
- Safety
- The composite primary safety outcome did not differ significantly between groups; serious adverse events related to rhythm-control therapy occurred in 4.9% with early rhythm control and 1.4% with usual care.
- Conclusion
- Early rhythm control was associated with a lower risk of adverse cardiovascular outcomes than usual care in patients with early atrial fibrillation and cardiovascular conditions.
- Why it matters
- It shifted the view of rhythm control from a strategy mainly for symptom relief toward one considered early after diagnosis with the aim of improving cardiovascular prognosis.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026