Arrhythmias & electrophysiologySecondary analysis
Interactions of blood biomolecules with early rhythm control in atrial fibrillation patients: exploratory analysis of the EAST-AFNET 4 biomolecule study
- Secondary analysis of the EAST-AFNET 4 randomised trial
- exploratory
- biomolecule substudy
- external replication cohorts
Authors' conclusion
ERC therapy is effective across patients with different severities of conditions associated with AF as quantified by biomolecule concentrations.
Study context
- Population
- Patients with atrial fibrillation (AF) and CV comorbidities in the EAST-AFNET 4 biomolecule study (median age 70 years; 45% women)14 biomarkers
- Participants
- 1,586 patients
- Comparison
- Early rhythm control (ERC) vs usual care (UC)
- Primary endpoint
- Interaction of 14 biomarkers with randomised treatment for the trial primary outcome:
- CV death
- Stroke
- Unplanned hospitalization for HF or ACS
Primary result
As reported in the abstract
Primary outcome by biomarker concentrations
- ERC reduced the primary outcome consistently across biomarker concentrations
- No signal for treatment interaction for 13 of 14 biomarkers
- BMP10: nominal interaction in categorical analyses, suggesting attenuated ERC effect in lowest BMP10 quintile; no interaction for continuous parameters
- All tests exploratory
Further findings
External replication cohort (BBC-AF and TRUST)
- Similar patterns observed
Original publication
Interactions of blood biomolecules with early rhythm control in atrial fibrillation patients: exploratory analysis of the EAST-AFNET 4 biomolecule study. Europace. Published 23 June 2026. doi:10.1093/europace/euag149
Summarised from the published abstract; every number is checked against it