Despite adequate treatment, cardiovascular problems occur in several individuals with heart failure and atrial fibrillation. Other therapies are needed to minimize these occurrences for people with heart failure with preserved left ventricular ejection fraction (HFpEF).
A randomized pre-specified sub-analysis, EAST - AFNET 4 trial evaluated the systematic effects of early rhythm control therapy (ERC) where catheter ablation or antiarrhythmic drugs were used compared to traditional/usual care (UC). Two primary outcomes were assessed in the trial along with specific secondary outcomes for heart failure patients (definition of heart failure symptoms as per NYHA II-III or with left ventricular ejection fraction [LVEF] <50%).
The study included 798 patients where 300 (37.6%) participants were female with median age of 71.0 [64.0, 76.0] years and 785 patients had known LVEF. The HFpEF (LVEF: ≥50%; mean LVEF: 61% ± 6.3%) was present in majority of the patients (n=442), whereas others had heart failure with reduced ejection fraction (n=132; LVEF: <40%; mean LVEF: 31% ± 5.5%), or mid-range ejection fraction heart failure (n=211; LVEF: 40-49%; mean LVEF: 44% ± 2.9%).
Also, the median follow-up of 5.1-year revealed that the composite primary outcome including stroke, cardiovascular mortality, or hospitalization due to worsening acute coronary syndrome or heart failure, were low in randomized patients receiving ERC (5.7 per 100 patient-years) as compared to randomized patients receiving UC (7.9 per 100 patient-years; hazard ratio [HR]- 0.74, p=0.03).
Furthermore, the primary safety outcome related to rhythm control therapy, such as serious adverse events, death, or stroke, occurred in 17.9% of randomized heart failure patients receiving ERC; whereas, it was 21.6% of patients with heart failure randomized to UC (HR: 0.85; p=0.33). However, LV ejection fraction improvement was noted in both groups. Also, the composite outcome of hospitalization due to heart failure worsening or death improved with ERC.
Patients with heart failure signs and symptoms diagnosed with atrial fibrillation can benefit from rhythm control treatment when started within one year after diagnosis.