Early Rhythm-Control Therapy May Improve Outcomes for AFib, Study Finds

Researchers have discovered that patients who are newly-diagnosed with atrial fibrillation can benefit from early intervention with a treatment known as rhythm-control therapy.

Atrial fibrillation (AFib) is a quivering or irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related complications, according to the American Heart Association (AHA).

Rhythm-control therapy, which works to regulate a patient’s heartbeat, is typically used after other methods of treating atrial fibrillation have proven ineffective. This type of therapy largely includes medication, but can also involve a surgical procedure.

For the study, which was published in The New England Journal of Medicine on August 29, researchers randomly assigned 2,789 patients from 135 medical centers who had been newly-diagnosed with AFib to two groups. The first group underwent rhythm-control therapy while the second received standard care, like medication to slow heart rate. Researchers followed patients for a little over five years.

During that time, the researchers found that patients in the early rhythm-control therapy group were less likely to die from cardiovascular causes, experience stroke, or be hospitalized for their condition. Only 249 patients in the early-rhythm control therapy experienced these complications, compared to 316 patients in the standard of care group.

“Early rhythm-control therapy was associated with a lower risk of cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions,” the study’s authors concluded.

“This is different from the current, delayed approach to rhythm-control therapy that only uses these rhythm-control treatments when patients remain symptomatic after initiation of other treatments, including medication to slow heart rate,” lead study author Paulus Kirchhof, MD, director of the department of cardiology at the University Heart and Vascular Centre and a professor at the University of Birmingham, tells Verywell.

At least 2.7 million people in the U.S. have AFib, the AHA says, making this a potentially crucial treatment for many.

Understanding Atrial Fibrillation

Atrial fibrillation is the most common type of treated heart arrhythmia, a condition when the heart beats too slow, too fast, or irregularly, according to the Centers for Disease Control and Prevention (CDC).

When someone has AFib, they have irregular beating in the upper chambers of their heart and blood doesn’t flow as well from those upper chambers to the lower ventricles of the heart. AFib can happen in short episodes or it can be a permanent condition, the CDC says.

How Rhythm-Control Therapy Can Help

Rhythm-control therapy is a term used to describe the use of either antiarrhythmic drugs—medications that suppress abnormal heart rhythms —or atrial fibrillation ablation, a surgical procedure, Kirchhof explains.

There is a big difference between the two, at least in how invasive they can be. “Antiarrhythmic drugs are administered by mouth," Jennifer Haythe, MD, an associate professor of medicine in the Center for Advanced Cardiac Care at Columbia University Irving Medical Center and co-director of the Columbia Women's Heart Center, tells Verywell. "Whereas an ablation is an invasive catheter-based procedure that involves the use of small burns or freezes to cause a small amount of scarring on the inside of the heart to help break up the electrical signals that cause atrial fibrillation.”

In the study, 95% of the patients who were given early rhythm-control therapy received an antiarrhythmic drug, like flecainide, dronedarone, amiodarone, or propafenone, while just 5% underwent an atrial fibrillation ablation. After two years, 19% of patients had received an atrial fibrillation ablation, and 46% of the patients were still taking antiarrhythmic drugs.

How is Atrial Fibrillation Usually Treated?

After a patient is diagnosed with AFib, the AHA says doctors typically work with them to reach several goals, including:

• Restoring the heart to a normal rhythm
• Reducing a high heart rate
• Preventing blood clots
• Managing risk factors for stroke
• Preventing other heart rhythm problems
• Preventing heart failure

A range of treatment options are used, but early treatment often relies on medication. These medications may include:

• Beta-blockers to slow heart rate
• Calcium channel blockers to slow heart rate and reduce the strength of the heart muscle’s contractions
• Digoxin to slow the rate of electrical currents within the heart

Patients may also be given medications to restore the heart rhythm to normal, like sodium channel blockers and potassium channel blockers.

Patients are also usually encouraged to make lifestyle changes. Some of the suggested changes patients can make include maintaining a healthy weight and diet, exercising regularly, and managing high blood pressure.

Why Is Early Rhythm-Control Therapy Successful?

Kirchhof says that using rhythm-control therapy earlier can simply be an additional treatment modality to get a patient’s AFib under control. In the study, it was used “on top of very good” management guidelines for patients with AFib, Kirchhof says.

“Over 90% of patients received oral anticoagulants—blood thinners that prevent strokes— and other therapies,” he says. “Early rhythm-control was effective when added to these treatments.”

Overall, Kirchhof says this is a promising early treatment. "It is hard to imagine that the effect is due to something else than early rhythm-control therapy," he says.