Background

Whether atrial fibrillation (AF) pattern or timing of AF therapy modifies the effectiveness of early rhythm control (ERC) is not known.

Objectives

This study sought to compare clinical characteristics and outcomes in patients presenting with different AF patterns on ERC vs usual care.

Methods

The effects of ERC were compared in first-diagnosed AF (FDAF), paroxysmal AF (paroxAF), and persistent AF (persAF) in this prespecified analysis of the EAST-AFNET 4 (Early treatment of atrial fibrillation for stroke prevention) trial. Associations between AF pattern and primary outcomes (first primary outcome: cardiovascular death, stroke, and hospitalization for heart failure and acute coronary syndrome; second primary outcome: nights spent in hospital per year) were compared over a mean follow-up of 5.1 years. Changes in health-related quality of life were assessed by the EQ-5D.

Results

FDAF patients (n = 1,048, enrolled 7 days after diagnosing AF) were slightly older (71 years of age, 48.0% female) than patients with paroxAF (n = 994, 70 years of age, 50.0% female) and persAF (n = 743, 70 years of age, 38.0% female). ERC reduced the primary outcome in all 3 AF patterns. Hospitalizations for acute coronary syndrome were highest in FDAF (incidence rate ratio [IRR]: 1.50; 95% CI: 0.83-2.69; P for interaction = 0.032) compared with paroxAF (IRR: 0.64; 95% CI: 0.32-1.25) and persAF (IRR: 0.50; 95% CI: 0.25-1.00). FDAF patients spent more nights in hospital (IRR: 1.38; 95% CI: 1.12-1.70; P for interaction = 0.004) than paroxAF (IRR: 0.84; 95% CI: 0.67-1.03), and persAF (IRR: 1.02; 95% CI: 0.80-1.30) patients. ERC improved health-related quality of life (EQ-5D score) in patients with paroxAF and persAF but not in patients with FDAF (P = 0.019).

Conclusions

ERC reduces the first primary composite outcome in all AF patterns. Patients with FDAF are at high risk for hospitalization and acute coronary syndrome, particularly on ERC. (Early treatment of atrial fibrillation for stroke prevention trial; ISRCTN04708680; Early Treatment of Atrial Fibrillation for Stroke Prevention Trial [EAST]; NCT01288352; Early treatment of Atrial fibrillation for Stroke prevention Trial [EAST]; EudraCT2010-021258-20)

中文翻译：

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心房颤动的呈现模式和早期节律控制治疗的结果

背景

房颤 (AF) 模式或 AF 治疗时机是否会改变早期节律控制 (ERC) 的有效性尚不清楚。

目标

本研究旨在比较在 ERC 与常规护理中出现不同 AF 模式的患者的临床特征和结果。

方法

在这项预先指定的 EAST-AFNET 4（心房颤动预防卒中的早期治疗）试验分析中，比较了 ERC 在首次诊断的 AF (FDAF)、阵发性 AF (paroxAF) 和持续性 AF (persAF) 中的效果。在平均 5.1 年的随访期间，比较了 AF 模式与主要结局（第一个主要结局：心血管死亡、中风和因心力衰竭和急性冠状动脉综合征住院；第二个主要结局：每年住院夜数）之间的关联。EQ-5D 评估了健康相关生活质量的变化。

结果

FDAF 患者（n = 1,048，在诊断 AF 后 7 天入组）比 paroxAF 患者（n = 994，70 岁，50.0% 女性）和 persAF（n = 743, 70 岁, 38.0% 女性)。ERC 降低了所有 3 种 AF 模式的主要结果。与paroxAF相比（IRR：0.64；95% CI ：0.32-1.25）和persAF（IRR：0.50；95% CI：0.25-1.00）。FDAF 患者在医院度过的夜晚更多（IRR：1.38；95% CI：1.12-1.70；交互作用P =0.004) 比 paroxAF (IRR: 0.84; 95% CI: 0.67-1.03) 和 persAF (IRR: 1.02; 95% CI: 0.80-1.30) 患者。ERC 改善了 paroxAF 和 persAF 患者的健康相关生活质量（EQ-5D 评分），但在 FDAF 患者中没有改善（P = 0.019）。

结论

ERC 减少了所有 AF 模式中的第一个主要复合结果。FDAF 患者住院和急性冠状动脉综合征的风险很高，尤其是在 ERC 上。（房颤早期治疗预防卒中试验；ISRCTN04708680；房颤早期治疗预防卒中试验[EAST]；NCT01288352；房颤早期治疗预防卒中试验[EAST]；EudraCT2010-021258-20）