Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial
Abstract Background and Aims Early rhythm-control improves cardiovascular outcomes in patients with atrial fibrillation (AF). Its effectiveness in patients with cancer is unclear. This study evaluated the effects of cancer history on early rhythm-control in the EAST-AFNET 4 trial. Methods This secondary analysis of EAST-AFNET 4 compared patients with and without a history of cancer, including active cancer and cancer in remission. Outcomes included the primary outcome, a composite of cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome; the safety outcome, a composite of death, stroke, and serious adverse events related to rhythm-control; and rhythm at 24 months. Results Cancer history was available in 2779/2789 patients (99.6%). Cancer history was present in 216/2779 (7.8%; 19 with active cancer; mean age, 73 years; 95 [44%] women; mean CHA2DS2-VASc score, 3.5). During a follow-up to 8.6 years, early rhythm control reduced the primary outcome in patients with and without a history of cancer (pinteraction = .23) with high rates of sinus rhythm at 24 months (cancer: 84.9%, without cancer: 81.8%; pinteraction = .60). In patients with a cancer history, there was a signal for more safety outcomes with early rhythm control (early rhythm control 36/116 [31%] patients with event, 22 deaths; usual care 20/100 [20%] patients with event, 18 deaths; pinteraction = .055). Conclusions Early rhythm control therapy appears effective in patients with AF and a history of cancer but may be less safe than in patients without cancer, in this hypothesis-generating analysis. This could be play of chance but warrants further research into the safety and efficacy of rhythm control therapy in patients with a cancer history.
Authors
- Isabelle C. Van Gelder (ORCID: https://orcid.org/0000-0002-7579-1201)
- Anna Suling (ORCID: https://orcid.org/0000-0002-8537-1948)
- Lars Eckardt (ORCID: https://orcid.org/0000-0002-3735-8503)
- Arif Elvan (ORCID: https://orcid.org/0000-0001-8436-8635)
- A. John Camm (ORCID: https://orcid.org/0000-0002-2536-2871)
- G. André Ng (ORCID: https://orcid.org/0000-0001-5965-0671)
- Hein Heidbüchel (ORCID: https://orcid.org/0000-0001-9301-8127)
- Sakis Themistoclakis (ORCID: https://orcid.org/0000-0002-7998-7113)
- Andreas Rillig (ORCID: https://orcid.org/0000-0003-3457-0936)
- Andreas Goette (ORCID: https://orcid.org/0000-0002-8223-7209)
- Günter Breithardt (ORCID: https://orcid.org/0000-0001-7574-8900)
- Katrin Borof
- Paulus Kirchhof (ORCID: https://orcid.org/0000-0002-1881-0197)
- Karl Wegscheider (ORCID: https://orcid.org/0000-0003-2974-3142)
- Larissa Fabritz (ORCID: https://orcid.org/0000-0002-9241-1733)
- Andreas Metzner (ORCID: https://orcid.org/0000-0002-6818-6396)
- Djemail Ismaili (ORCID: https://orcid.org/0000-0001-8709-0448)
- Antonia Zapf (ORCID: https://orcid.org/0000-0002-8467-0508)
- Stephan Willems (ORCID: https://orcid.org/0000-0002-8890-5749)
- Josef Kautzner (ORCID: https://orcid.org/0000-0002-1632-6182)
- Panos Vardas (ORCID: https://orcid.org/0000-0002-4499-0806)
- Renate B. Schnabel (ORCID: https://orcid.org/0000-0001-7170-9509)
- Harry J.G.M. Crijns (ORCID: https://orcid.org/0000-0003-1073-5337)
- Marc D. Lemoine (ORCID: https://orcid.org/0000-0002-3799-7962)
- Łukasz Szumowski
- Laurent Haegeli
- Michele Gulizia
Institutions
- University Medical Center Groningen (NL)
- University of Antwerp (BE)
- Universität Hamburg (DE)
- St George's, University of London (GB)
- Maastricht University (NL)
- Biomedical Research Foundation of the Academy of Athens (GR)
- University Hospital of Zurich (CH)
- Antwerp University Hospital (BE)
- University Hospital Münster (DE)
- Ospedale Garibaldi (IT)
- Zurich Heart House (CH)
- University Medical Center Hamburg-Eppendorf (DE)
- Atrial Fibrillation NETwork (DE)
- Klinikum Braunschweig (DE)
- Asklepios Klinik St. Georg (DE)
- German Centre for Cardiovascular Research (DE)
- Institute of Clinical and Experimental Medicine (CZ)
- University Hospital of Heraklion (GR)
- Ospedale dell' Angelo (IT)
- Narodowy Instytut Leków (PL)
- NIHR Leicester Biomedical Research Centre (GB)
- HAW Hamburg (DE)
- University of Birmingham (GB)
- Otto-von-Guericke-Universität Magdeburg (DE)
Publication Details
- Journal
- EP Europace
- Published
- 2026-09-17
- DOI
- https://doi.org/10.1093/europace/euag269
- Primary Topic
- Atrial Fibrillation Management and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 0.00