A 50-year-old man with no structural heart disease has symptomatic paroxysmal AF. Rate control has not been satisfactory. He is now being considered for rhythm control. The EAST-AFNET 4 trial demonstrated which key finding relevant to AF rhythm control strategy?
- A Early rhythm control significantly reduced the composite of cardiovascular death, stroke, and heart failure hospitalisation compared to usual care ✓
- B Rate control is superior to rhythm control for cardiovascular outcomes in early AF
- C Rhythm control with antiarrhythmics only (no catheter ablation) showed no mortality benefit
- D Ablation should be the first-line rhythm control strategy based on EAST-AFNET 4 results
Explanation
The EAST-AFNET 4 trial demonstrated that early rhythm control (initiated within 1 year of AF diagnosis) significantly reduced the primary composite outcome (cardiovascular death, stroke, hospitalisation for worsening heart failure or ACS) by 21% compared to usual care (predominantly rate control) in patients with early AF (<1 year diagnosis) and cardiovascular risk factors. This changed AF management paradigm: earlier rhythm control is now recommended even in asymptomatic or mildly symptomatic patients. The strategy included antiarrhythmic drugs and/or catheter ablation. The AFFIRM trial previously showed no survival difference, but enrolled patients with longer-standing AF.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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