Early Rhythm Control Strategy in Early Atrial Fibrillation Patients

A Retrospective Cohort Study

Abstract

Atrial fibrillation (AF) pharmaceutical treatment strategy on when to start rhythm control has been debated for decades. In early studies, these 2 strategies exhibited equivalent efficacy; however, more recent studies based on CHA₂DS₂-VASc score indicated that early rhythm control (ERC) is more beneficial than UC. We hypothesized that ERC might benefit persons with AF in other cardiovascular outcomes, regardless of the CHA₂DS₂-VASc score. To elucidate this, we conducted the present study.

A retrospective cohort study was conducted using the Yinzhou Regional Health Care Database. We included all patients diagnosed with AF within 1 year and excluded those without age/sex information, without ERC/UC treatment prescription, or with ongoing cancer. The primary outcome was major cardiovascular events (MACE). We used inverse probability of treatment weighting (IPTW) for covariate weighting.

A total of 7,161 patients diagnosed with early-stage AF were included in this study. Of them, 2,248 and 4,913 were included in the ERC and UC groups, respectively. During the mean follow-up period of 3.2 years (27,945 person-year), and after IPTW, ERC showed significantly lower risk for MACE (HR: 0.75 [0.61, 0.96], P = 0.02) and heart failure (HF; HR: 0.71 [0.54, 0.95], P = 0.01). No significant results were obtained for stroke, cardiovascular death, or all-cause mortality.

ERC is more beneficial to early-stage Persons with AF than UC for MACEs, particularly HF.