Early Rhythm Control Benefits Even Asymptomatic Patients with Atrial Fibrillation

In the EAST-AFNET 4 randomized trial (NCT01288352), involving patients with new-onset (<1 year) atrial fibrillation (AF), incidence of a first primary-outcome event — cardiovascular death, stroke, or hospitalization with worsening heart failure or acute coronary syndrome — was significantly lower with early rhythm control than with usual care (initial aggressive rate control, rhythm control for symptoms; see NEJM JW Cardiol Oct 2020 and N Engl J Med 2020; 383:1305, 1383). In a prespecified analysis, researchers now report specifically on the 801 asymptomatic trial participants (30% of the cohort).

Asymptomatic patients were older, more often male, and had less heart failure — but had higher rates of prior stroke or transient ischemic attack …