The EAST-AFNET 4 (Early Treatment of Atrial Fibrillation to Prevent Stroke) trial investigated whether rhythm control treatment with antiarrhythmic drugs or atrial fibrillation ablation within one year of AF diagnosis improves outcomes. Main findings published in 2020 demonstrate clinical benefit of early rhythm control therapy in patients with AF and comorbidities: ERC combined with antiarrhythmic drugs and/or AF ablation reduced primary outcome, composite of cardiovascular death, stroke and hospitalization ending. During 5 years of follow-up, 2,789 patients with early AF and cardiovascular risk factors had worsening heart failure or acute coronary syndrome compared with usual care (UC).
"The EAST-AFNET 4 trial showed that systemic early rhythm control reduced cardiovascular outcomes by 21% compared with usual care. However, it is unclear which components of early rhythm control treatment contributed to the reduction in outcomes. Identifying possible as observed mediators of treatment effect, we scrutinized the EAST-AFNET 4 trial dataset for early rhythm control factors associated with lower cardiovascular outcomes."
All participants in the EAST-AFNET 4 trial were examined at the study visit 12 months after randomization. At that time, 90% of study patients (1257/1395 randomized to early rhythm control and 1260/1394 randomized to usual care) had not met the first primary outcome. Data from these patients were included in the mediation analysis.
Many drugs can trigger arrhythmias, including antiarrhythmic drugs (drugs that prevent and/or treat abnormal heartbeats) themselves. The side effects of proarrhythmic drugs have been extensively studied because in rare cases they have been shown to induce life-threatening ventricular tachycardia and conduction disturbances.
Some drugs can trigger atrial fibrillation, which is rarely fatal by itself, but it can cause severe discomfort and death and increase the risk of stroke.
Drug-induced arrhythmias and sudden death are uncommon events that occur in unpredictable ways, but it is important to understand your risk and the drugs associated with these events - especially for those with structural abnormalities or high risk of heart disease .
Most drugs that cause arrhythmias do so in one of several ways:
Adrenaline or vagus nerve stimulation, which improves cardiac output by increasing heart rate and increasing contractility.
This drug is directly toxic to the heart (cardiotoxicity).
The drug alters the way electrical signals are conducted in the heart's atria, thereby altering atrial conduction, refractory periods, or automaticity.
This drug constricts coronary blood vessels, cutting off blood flow (vasoconstriction and ischemia).
This drug causes local electrolyte disturbances in the heart.