Arrhythmias & electrophysiologySecondary analysis
Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial
- Secondary analysis of the EAST-AFNET 4 randomised trial
- subgroup analysis
- hypothesis-generating
Authors' conclusion
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.
Study context
- Population
- Patients with atrial fibrillation (AF) in EAST-AFNET 4, with and without a history of cancer (active or in remission)216 with cancer history
- Participants
- 2,779 patients
- Comparison
- Early rhythm control vs usual care, by history of cancer
- Primary endpoint
- Composite of:
- CV death
- Stroke
- Hospitalisation for worsening HF or ACS
Primary result
As reported in the abstract
Primary outcome, by cancer history (subgroups) · follow-up to 8.6 years
Early rhythm control reduced the primary outcome in patients with and without a history of cancer
pinteraction = .23
Further findings
Sinus rhythm, by cancer history · 24 months
- Sinus rhythm, by cancer history: interaction P = .60
Safety
Safety outcome (death, stroke, serious AEs related to rhythm control), cancer history subgroup
Deaths Early rhythm control 22 · Usual care 18
- Safety outcome (death, stroke, serious AEs related to rhythm control), cancer history subgroup: interaction P = .055
Safety outcome (death, stroke, serious AEs related to rhythm control), cancer history subgroup
- Signal for more safety outcomes with early rhythm control in patients with a cancer history
Original publication
Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial. Europace. Published 18 September 2026. doi:10.1093/europace/euag269
Summarised from the published abstract; every number is checked against it