News | 4 September 2020

Early treatment of atrial fibrillation means fewer complications later

The evidence comes from a large-scale international study involving close to 2,800 patients in 135 hospitals

Early treatment of chronic arrhythmia reduces the risk of serious cardiovascular complications and death, unlike the current standard protocol of merely monitoring and managing symptoms. These are the conclusions that a team of international researchers will publish today in the prestigious New England Journal of Medicine (NEJM). Prof. Dr. Harry Crijns (Head of Cardiology at Maastricht UMC+) is one of the lead researchers: "These findings will have a major impact on how we treat atrial fibrillation."

iStockiStockAtrial fibrillation is the most common form of cardiac arrhythmia. It is generally believed that treatment is not immediately necessary if the patient is not experiencing any symptoms. The standard approach is to begin by monitoring the heart rhythm and manage atrial fibrillation-related symptoms where necessary. Following diagnosis, however, cardiovascular complications, for example stroke, heart failure or heart attack, can arise over time and may even result in death. It was thought that early rhythm-control therapy could reduce the number of patients with such complications, but hard evidence was lacking until now.

Decline in incidence of complications
The researchers compared the current method, monitoring, with early rhythm-control therapy in the form of ablation (cauterising the electrical pathways in the heart) or treatment with antiarrhythmic drugs. The study ultimately involved no less than 2,789 patients from 135 hospitals in 11 European countries, including Maastricht UMC+ and a number of other Dutch hospitals. Half of the patients received early rhythm-control therapy, whereas the other half were subject to the standard protocol of monitoring and symptom management. Within one year, the incidence of serious complications declined to 3.9 percent in the group of patients actually receiving early rhythm-control therapy, compared to 5 percent in the group adhering to the standard protocol.

Improving treatment
"It may seem like a small gain," says Crijns, "but if we convert that into absolute figures on an annual basis, then we're talking about hundreds of patients in the Netherlands every year who will be spared serious suffering. And those are only the patients that end up in hospital." The results published in the New England Journal of Medicine argue for a different approach to atrial fibrillation, Crijns believes. "Treatment is and will always be on a case-by-case basis, but we have shown that early ablation or drug therapy can be beneficial for patients. Atrial fibrillation is by no means a harmless condition."