Pressemitteilung

Many patients with atrial fibrillation (AF) experience stroke, cardiovascular death and other cardiovascular complications. Early rhythm control can prevent some of these events but is often withheld from elderly patients with multiple comorbidities. Catheter ablation is the most effective rhythm-controlling therapy but has mainly been tested in younger patients. The German Atrial Fibrillation Network (AFNET) initiated the EASThigh – AFNET 11 trial to investigate whether early catheter ablation can reduce outcomes in patients with AF and comorbidities. EASThigh – AFNET 11 enrolled the first patient on 14.10.2024.

Atrial fibrillation (AF) epidemic affects the health of a growing number of people worldwide. Patients with AF are at risk of stroke, heart failure, death and dementia. Many patients develop AF in old age, and older people with cardiovascular comorbidities are at highest risk of AF-related complications.

A combined subgroup analysis of the similar trials NOAH – AFNET 6 (1) and ARTESiA (2) revealed: Patients with device-detected atrial fibrillation and concomitant vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from oral anticoagulation than those without vascular disease. The finding was presented by AFNET Steering Committee member Prof. Renate Schnabel, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, at the annual congress of the European Society of Cardiology (ESC) in London on 02.09.2024 and published in the European Heart Journal (3).

Device-detected atrial fibrillation (DDAF) are short and typically rare episodes of atrial fibrillation (AF) detected by pacemakers, defibrillators, or implanted loop recorders. Device-detected atrial fibrillation is found in every fifth patient with a cardiac implanted electronic device (4). Device-detected atrial fibrillation can lead to stroke, but the stroke risk in patients with device-detected atrial fibrillation appears lower than the stroke risk in patients with ECG-documented atrial fibrillation (1%/year).

Low concentrations of three selected biomarkers in the blood of patients with atrial fibrillation identify patients with a high chance of attaining sinus rhythm. This is the main result of this analysis of the EAST – AFNET 4 biomolecule study. Today the findings have been presented by AFNET Steering Committee member Prof. Larissa Fabritz, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany, at the annual congress of the European Society of Cardiology (ESC) in London and published in the European Heart Journal (1).

Atrial Fibrillation (AF) is the most common arrhythmia in senior people. AF often occurs in patients with cardiovascular comorbidities. Recurrent AF is determined by interactions between cardiovascular disease processes and rhythm-control therapy. Predictors of attaining sinus rhythm at follow-up are not well known.

An international cardiology working group has published a consensus report on atrial cardiomyopathy (1). 21 scientists from the rhythmological societies of Europe (European Heart Rhythm Association (EHRA)), North America (Heart Rhythm Society (HRS)), South America (Latin American Heart Rhythm Society (LAHRS)) and the Asia-Pacific region (Asia Pacific Heart Rhythm Society APHRS) were involved. The expert group was led by AFNET board member Prof. Andreas Goette, Paderborn, Germany. He presented the results on August 31, 2024 at the annual congress of the European Society of Cardiology (ESC) in London.

Atrial cardiomyopathy (AtCM) refers to pathological changes in the heart’s atria, including the atrial muscle cells. They contribute to the development of atrial fibrillation, can cause blood clots and strokes and are therefore of fundamental clinical importance.

A subgroup analysis of the NOAH – AFNET 6 trial revealed: In patients with device-detected atrial fibrillation and a prior stroke, oral anticoagulation increases bleeding without a clear reduction in stroke. This finding was presented by Prof. Paulus Kirchhof, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, in a late-breaking clinical trials session at the annual congress of the American Heart Rhythm Society (HRS) in Boston, USA, on 19.05.2024 (1).

Device-detected atrial fibrillation (DDAF) are short and typically rare episodes of atrial fibrillation (AF) detected by pacemakers, defibrillators, and implanted loop recorders capable of continuous rhythm monitoring. Device-detected atrial fibrillation is found in every fifth patient with a cardiac implanted electronic device (2). Device-detected atrial fibrillation can lead to stroke, but the stroke risk in patients with device-detected atrial fibrillation appears lower than the stroke risk in patients with ECG-documented atrial fibrillation (1%/year).

Anticoagulation effectively prevents stroke in patients with ECG-documented AF. It is particularly effective in patients with AF and a prior stroke or transient ischemic attack (TIA) who are at high risk of recurrent stroke. In patients with a prior stroke without ECG-documented AF, oral anticoagulants mainly increase bleeding with only a weak effect on ischemic stroke.

An analysis of the biomolecule substudy of the EAST – AFNET 4 trial revealed: biomolecule concentrations in the blood of patients with atrial fibrillation can be used to identify patients at high and low cardiovascular risk. Today the findings were presented by Prof. Larissa Fabritz, University Medical Center Hamburg Eppendorf, Hamburg, Germany, at the Frontiers in CardioVascular Biomedicine Congress in Amsterdam and published in Cardiovascular Research (1).

Atrial Fibrillation (AF) is the most common arrhythmia in elderly people. AF often occurs in patients with cardiovascular comorbidities with shared disease mechanisms. Little is known about the disease processes leading to AF-related complications and their interactions in patients with AF.

In patients with device-detected atrial fibrillation and a high comorbidity burden, oral anticoagulation increases bleeding without a clear reduction in stroke. This is the main finding of a sub-analysis of the NOAH – AFNET 6 trial presented by Dr Julius Nikorowitsch, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, in a late-breaking science session at the annual congress of the European Heart Rhythm Association (EHRA) in Berlin, Germany, today and simultaneously published in the European Heart Journal (1).

Device-detected atrial fibrillation (DDAF) are short and typically rare episodes of atrial fibrillation (AF) detected by pacemakers, defibrillators, and implanted loop recorders capable of continuous rhythm monitoring. Device-detected atrial fibrillation is found in every fifth patient with a cardiac implanted electronic device (2). Device-detected atrial fibrillation can lead to stroke, but the stroke risk in patients with device-detected atrial fibrillation appears lower than the stroke risk in patients with ECG-documented atrial fibrillation.

An international panel of experts published recommendations to improve management of atrial fibrillation (AF). The position pAn international panel of experts published recommendations to improve management of atrial fibrillation (AF). The position paper summarizes the results of the 9th AFNET/EHRA consensus conference – a two-day expert meeting which was jointly organized by the German Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA) in Münster, Germany, in September 2023. Today the consensus report was presented at the EHRA congress in Berlin by Prof. Dominik Linz, Maastricht, The Netherlands, and simultaneously published in Europace (1).

Atrial fibrillation (AF) is the most common arrhythmia and a growing health problem in an aging society. It affects several million people in Europe and worldwide.

Investigator-initiated trials led by the German Atrial Fibrillation NETwork (AFNET) provide evidence for several recommendations in the 2023 guideline for the diagnosis and management of atrial fibrillation (AF) developed by the American College of Cardiology (ACC) and the American Heart Association (AHA) in collaboration with the Heart Rhythm Society (HRS). The updated guideline has recently been published in Circulation (1).

During the past 20 years, AFNET delivered a set of investigator-initiated trials in the field of atrial fibrillation. The results of these trials now provide evidence for several recommendations in the 2023 American guideline for the diagnosis and management of AF.

The 10 take home messages emphasize the importance of early and continued management of patients with AF that should focus on maintaining sinus rhythm and minimizing AF burden. This new recommendation is based on the results of the EAST – AFNET 4 trial (2). The up-to-date guidance contains the following new recommendation: “In patients with a recent diagnosis of AF (<1 year), rhythm control can be useful to reduce hospitalizations, stroke, and mortality.” (Section 8.1 on rhythm control therapy). This means that early rhythm control therapy should be considered in all patients fulfilling the enrolment criteria of EAST – AFNET 4. Several sub-studies of EAST – AFNET 4 have influenced the recommendations on rhythm control in patients with atrial fibrillation and heart failure, in asymptomatic patients, and in other subgroups.

In patients with device-detected atrial fibrillation the risk of stroke appears low (1% per year) compared to patients with ECG-detected atrial fibrillation, even in patients with long episodes. Anticoagulation can slightly reduce stroke risk, but also increase major bleeding. This is the main finding of a sub-analysis of the NOAH – AFNET 6 trial presented by Dr Nina Becher, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, in the late-breaking clinical trials session at the annual congress of the American Heart Association (AHA) in Philadelphia, USA, and published on 12th November, 2023, in the European Heart Journal (1).