Graphical Abstract
Delayed AF ablation retains its efficacy.
When added to continued oral anticoagulation and good management of concomitant cardiovascular conditions, rhythm control therapy is slowly shifting from a symptom-directed treatment[1] to a pillar of outcome reduction in patients with atrial fibrillation (AF) and stroke risk factors.[2] This change in clinical practice is based on the outcome-reducing effects of an early rhythm control therapy strategy observed in the EAST-AFNET 4 trial,[3] including in asymptomatic patients.[4] Early rhythm control therapy using a combination of antiarrhythmic drugs, supplemented by AF ablation in a quarter of patients at 2 years, is not only effective but is also cost-effective at accepted thresholds based on German healthcare utilization and cost data.[5] Analyses in electronic health records and population-based datasets demonstrate the safety of modern rhythm control therapy and replicate the outcome-reducing effect of early rhythm control in non-randomized analyses.[6–8] The resulting tectonic shift in the demand for rhythm control therapy is beginning to be felt across specialist AF services and is likely to intensify.
In this issue of the European Heart JournalJonathan Kalman and colleagues report the primary outcome of a small, well-conducted, randomized trial comparing the effectiveness of early AF ablation with that of AF ablation delayed by a year of antiarrhythmic drug therapy in patients with paroxysmal or persistent AF.
