Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial

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ID: 329073
2026
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Abstract
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.
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Authors Djemail Ismaili, Anna Suling, Katrin Borof, Andreas Goette, Günter Breithardt, A. John Camm, Harry J.g.m. Crijns, Lars Eckardt, Arif Elvan, Larissa Fabritz, Isabelle C. Van Gelder, Michele Gulizia, Laurent Haegeli, Hein Heidbüchel, Josef Kautzner, Marc D. Lemoine, G. André Ng, Renate B. Schnabel, Łukasz Szumowski, Sakis Themistoclakis, Panos Vardas, Karl Wegscheider, Stephan Willems, Antonia Zapf, Andreas Metzner, Andreas Rillig, Paulus Kirchhof
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Journal EP Europace
Year 2026
DOI
10.1093/europace/euag269
URL
https://doi.org/10.1093/europace/euag269
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