Atrial Fibrillation Controlled with 'Early Rhythm Control Therapy'

Severance Hospital and CHA University Research Team
Rhythm Control More Effective Than Rate Control in Middle-Aged Stroke Patients with Lower Risk

[Asia Economy Reporter Lee Gwan-joo] A study has found that early rhythm control therapy is more effective than rate control therapy even in atrial fibrillation patients with a low risk of stroke.

The research team led by cardiologists Jeong Bo-young and Kim Dae-hoon from Severance Hospital and professors Sung Jeong-hoon and Yang Pil-seong from CHA University College of Medicine announced on the 7th that early rhythm control therapy within one year of atrial fibrillation diagnosis reduces the probability of complications such as stroke compared to other treatment methods, even in patients with a low risk of stroke.

Atrial fibrillation is the most common arrhythmia in which the atria fail to contract or relax normally, disrupting the heart rhythm. Because blood flow becomes irregular, blood clots form and can lead to stroke. In fact, it is known to increase the risk of stroke by five times, and 20% of all strokes are caused by atrial fibrillation.

Treatment is based on anticoagulants to prevent stroke, combined with rhythm control therapy that restores normal atrial rhythm and rate control therapy that only controls the heart rate. Rhythm control therapy is an active concept that goes beyond simply controlling the heart rate by adding procedures such as catheter ablation to treat the heart rhythm itself. However, there have been questions about the treatment effect due to the toxicity of antiarrhythmic drugs used in rhythm control therapy.

Following previous research confirming that rhythm control therapy within one year is more effective than rate control therapy in patients with a high risk of stroke, the research team investigated whether early rhythm control therapy is also more effective in patients with a low risk of stroke.

To assess the stroke risk in atrial fibrillation patients, the research team used the 'CHA2DS2-VASc score,' a calculation method predicting stroke risk based on hypertension, diabetes, age, and other factors. The study was conducted on 16,659 atrial fibrillation patients with a low risk of stroke (CHA2DS2-VASc score below 2) from 2011 to 2015 using data from the National Health Insurance Service.

As a result, the annual incidence rate of the primary composite outcome was 1.6% in the rhythm control group, which was 19% lower than the 2% in the rate control group. There was no significant difference in composite safety events between the rhythm control and rate control groups. Additionally, the risk rate was investigated in atrial fibrillation patients with a high risk of stroke (CHA2DS2-VASc score 2 or higher), and the primary composite outcome occurred at an annual rate of 6.6% in the rhythm control group, which was 14% lower than the 7.7% in the rate control group.

Regardless of stroke risk, there was no difference in the risk of composite safety events between the rhythm control and rate control groups, demonstrating the safety of rhythm control therapy compared to rate control therapy. Rhythm control therapy was particularly effective in middle-aged patients under 65 years old with a low CHA2DS2-VASc score.

Professor Jeong explained the significance of this study, saying, “Following previous research showing that early rhythm control therapy is superior in patients with a high risk of stroke, this study revealed that early rhythm control started at the initial diagnosis is also more effective than rate control in patients with a low risk.” Professor Sung emphasized, “It is important for atrial fibrillation patients to receive rhythm control therapy within one year of diagnosis to prevent stroke and other complications.”

The results of this study were published in the latest issue of the official journal of the American College of Physicians, Annals of Internal Medicine (IF 51.598).

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