{ "release_id": "f6f6f1b6f50379ed", "id": "cardio:af-rhythm-control", "owner": "cardio", "kind": "intervention", "slug": "af-rhythm-control", "name": "Rhythm control for AF (medicines or catheter ablation)", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "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%).", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "arrhythmias" ] } }, "payload": { "subtype": "procedure", "mechanism": "Restores a normal heart rhythm with antiarrhythmic medicines, electrical cardioversion or catheter ablation (a US government patient page; the trial used antiarrhythmic drugs or ablation).", "components": null }, "content_digest": "b020b79f7e66a042be05111fcf392d1aa69a18359df33ea0be1ddf11b8e36d45", "review": { "content_digest": "b020b79f7e66a042be05111fcf392d1aa69a18359df33ea0be1ddf11b8e36d45", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-early-rhythm-control-east-afnet-4", "owner": "cardio", "subject_entity_id": "cardio:af-rhythm-control", "category": "effect", "statement": "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.", "context": { "id": "cardio:ctx-east-afnet-4-early-af-and-cardiovascular-conditions", "label": "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_note": "Adults; the abstract does not give an age range.", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Median of 5.1 years of follow-up per patient. The trial was stopped for efficacy at the third interim analysis.", "eligibility": { "inclusion": [ "Atrial fibrillation diagnosed 1 year or less before enrollment", "Cardiovascular conditions (the abstract does not say which)" ], "exclusion": [ "Not stated in the abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "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. 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