Arrhythmias & electrophysiologySecondary analysis
Effectiveness and Safety of Early Rhythm Control in Patients With Atrial Fibrillation and Chronic Kidney Disease
- Secondary analysis of the EAST-AFNET 4 randomised trial
- predefined secondary analysis
- subgroup analysis by chronic kidney disease (CKD)
Authors' conclusion
ERC effectively and safely reduces cardiovascular events in patients with recently diagnosed AF and stroke risk factors with and without CKD.
Study context
- Population
- Patients with recently diagnosed atrial fibrillation (AF) and comorbidities, by CKD (glomerular filtration rate (GFR) <60 mL/min/1.73 m²)2,742 with baseline creatinine
- Participants
- 2,789 patients
- Comparison
- Early rhythm control vs usual care, by CKD status
- Primary endpoint
- CV death, stroke, hospitalization for worsening HF, or ACS
Primary result
As reported in the abstract
Primary outcome by CKD status
- no CKD: 3.4% vs 4.1%/100 patient-years
- HR 0.84; P < 0.001
- CKD: 5.8% vs 8.5%/100 patient-years
- HR 0.67; P < 0.001
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Primary outcome per mL GFR decrease · 5.1 years of follow-up | 0.98 (0.97–0.99) | |
| 0.512Hazard ratio (log scale) |
AF recurrence
- More AF recurrences with usual care (UC) in patients with CKD
- P for interaction = 0.036
Death, stroke, serious rhythm control-related AEs
- CKD increased safety outcomes without interaction with ERC
- P for interaction = 0.927
Original publication
Effectiveness and Safety of Early Rhythm Control in Patients With Atrial Fibrillation and Chronic Kidney Disease. J Am Coll Cardiol. Published 13 May 2026. doi:10.1016/j.jacc.2026.03.087
Summarised from the published abstract; every number is checked against it