# Rhythm control for AF (medicines or catheter ablation) Intervention · id `cardio:af-rhythm-control` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, organ or system: Heart Browse, condition area: Heart rhythm problems ## In plain language Rhythm control aims to restore and keep a normal heartbeat in atrial fibrillation, with heart rhythm medicines, electrical cardioversion or catheter ablation. A US government patient page describes it as a choice for people whose symptoms persist despite medicines that control the heart rate, and for people whose atrial fibrillation is new. In the EAST-AFNET 4 trial, starting rhythm control early in people with recently diagnosed atrial fibrillation and other cardiovascular conditions led to fewer first major events than usual care (3.9 compared with 5.0 per 100 person-years), and also to more serious adverse events related to rhythm-control therapy (4.9% compared with 1.4%). ## Technical summary Strategy page. A US government patient page describes medicines that change an abnormal rhythm to a normal one, electrical cardioversion with low-energy shocks and catheter ablation, which destroys the tissue causing the arrhythmia. In EAST-AFNET 4, early rhythm control was treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization; usual care limited rhythm control to managing symptoms. The comparison is a strategy against usual care. It is not a comparison of drugs with ablation. Results are on the claim: the trial was stopped for efficacy, and the abstract gives the first primary outcome and the safety outcome as reported. ## Claims, with the population each applies to ## Context: Adults with early atrial fibrillation and cardiovascular conditions (EAST-AFNET 4) Recipient: Adult; Population: Patients with early atrial fibrillation, diagnosed 1 year or less before enrollment, who also had cardiovascular conditions. The abstract gives a median time since diagnosis of 36 days and does not list the conditions.; Care setting: An international trial in 135 centers.; Geography: International; the abstract does not list the countries.; Life stage: Adults; the abstract does not give an age range.; Follow-up: Median of 5.1 years of follow-up per patient. The trial was stopped for efficacy at the third interim analysis. ### In EAST-AFNET 4, an international, investigator-initiated, open, parallel-group trial with blinded outcome assessment, 2789 patients with early atrial fibrillation (diagnosed 1 year or less before enrollment, median time since diagnosis 36 days) and cardiovascular conditions were randomly assigned in 135 centers to early rhythm control (antiarrhythmic drugs or atrial fibrillation ablation after randomization) or to usual care, which limited rhythm control to managing symptoms. 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 (death from cardiovascular causes, stroke, or hospitalization with worsening heart failure or acute coronary syndrome) occurred in 249 patients assigned to early rhythm control (3.9 per 100 person-years) and 316 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 second primary outcome, nights spent in the hospital per year, did not differ significantly (5.8 and 5.1 days per year, P = 0.23). The percentage of patients with a primary safety outcome event (death, stroke, or serious adverse events related to rhythm-control therapy) did not differ significantly between groups, but serious adverse events related to rhythm-control therapy occurred in 4.9% of patients assigned to early rhythm control and 1.4% of those assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly. - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Patients with early atrial fibrillation, diagnosed 1 year or less before enrollment, who also had cardiovascular conditions. The abstract gives a median time since diagnosis of 36 days and does not list the conditions.; Care setting: An international trial in 135 centers.; Geography: International; the abstract does not list the countries.; Life stage: Adults; the abstract does not give an age range.; Follow-up: Median of 5.1 years of follow-up per patient. The trial was stopped for efficacy at the third interim analysis. - Limitations: Open-label trial with blinded outcome assessment, stopped early for efficacy, which can overstate an effect. Abstract only: the full text and the registry record were not read, so eligibility details, the countries and the ablation share are not recorded. The confidence interval is a 96% interval. The comparison is early rhythm control against usual care, not one rhythm-control method against another. Serious adverse events related to rhythm-control therapy were more frequent with early rhythm control. - Last checked: 2026-10-14 - Sources: 1. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Design and population (first fragment). 2. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 1, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Design and population (second fragment). 3. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Definition of early rhythm control. 4. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 3. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Definition of usual care. 5. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 4, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: First primary outcome (first fragment). 6. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 4, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Second primary outcome. 7. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, METHODS, sentence 5. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Primary safety outcome. 8. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Centers, patients and time since diagnosis. 9. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Stopped for efficacy; follow-up. 10. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 3, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: First primary outcome events (first fragment). 11. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 3, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: First primary outcome hazard ratio (second fragment). 12. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 4, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Nights in hospital did not differ (first fragment). 13. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 4, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Nights in hospital P value (second fragment). 14. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 5, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Safety outcome did not differ (first fragment). 15. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 5, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Serious adverse events related to rhythm-control therapy (second fragment). 16. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 5, fragment 3. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Serious adverse events (third fragment). 17. Supports: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 6. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: Symptoms and left ventricular function did not differ. 18. Background: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, CONCLUSIONS, sentence 1, fragment 1. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: The authors' conclusion (first fragment). 19. Background: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-14 through NCBI E-utilities. The first attempt returned no usable response because the harvester discarded a reply that contained the API key (label cf-pubmed-32865375-attempt.xml); the second attempt succeeded. The full text and the version of record were not fetched.) Locator: Abstract, CONCLUSIONS, sentence 1, fragment 2. Retrieved 2026-10-14T18:18:46Z. Source state: Current. Snapshot hash: 038f34fce1c09d6eed021494032456c3851fb67be829d4fe8c1ec5549ef00fa0. How it applies: The authors' conclusion (second fragment). ## Connected pages - Early rhythm control against usual care in EAST-AFNET 4: Atrial fibrillation (AF) (`cardio:atrial-fibrillation`) [a claim, not a settled fact; see claim `cardio:claim-early-rhythm-control-east-afnet-4` and its context] - Filed under this front: Procedures and surgery (`cardio:front-procedures-and-surgery`) ## Provenance Content hash: b020b79f7e66a042be05111fcf392d1aa69a18359df33ea0be1ddf11b8e36d45 Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-14