ABSTRACT NUMBER: ESOC2026OT120 EARLY TREATMENT OF ATRIAL FIBRILLATION FOR STROKE PREVENTION TRIAL IN ACUTE STROKE (EAST-STROKE)

Abstract Background and aims Acute stroke patients with atrial fibrillation (AF) have a particularly high risk of suffering from recurrent stroke and other cardiovascular complications. It is uncertain whether early rhythm control is effective and safe in preventing recurrent strokes and cardiovascular complications in patients with AF and an acute ischaemic stroke. Methods To test whether early rhythm-control therapy in addition to usual care is effective and safe in patients with acute ischaemic stroke and AF. Results EAST-STROKE is an international investigator-initiated, prospective, randomised, open, blinded endpoint assessment (PROBE) interventional multi-centre trial. Patients with acute ischaemic stroke and AF will be randomised (1:1) to receive either early rhythm control and usual care or usual care alone. Usual care includes oral anticoagulation, rate control, and treatment of cardiovascular conditions. Early rhythm control additionally comprises treatment with antiarrhythmic drugs, AF ablation or cardioversion. A minimum of 1,746 participants will be randomised to observe 351 events. Conclusions The primary outcome is a composite of first recurrent ischaemic stroke, haemorrhagic stroke, unclassified stroke, cardiovascular death, or hospitalization due to worsening of heart failure or due to acute coronary syndrome, analysed as time to the first occurrence. Secondary outcomes include individual components of the primary outcome, functional status and patient-reported outcome measures. Safety outcomes comprise all-cause mortality and adverse events. Conflict of interest