Early rhythm control in patients with atrial fibrillation and cancer: a subgroup analysis of the EAST-AFNET 4 trial
Abstract
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 and results: 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. Cancer history was available in 2779 of 2789 patients (99.6%). Cancer history was present in 216 of 2779 (7.8%; 19 with active cancer; mean age, 73 years; 95 [44%] women; mean CHA2DS2-VASc score, 3.5). During a follow-up of 8.6 years, early rhythm control reduced the primary outcome in patients with and without a history of cancer (Pinteraction = 0.23) with high rates of sinus rhythm at 24 months (cancer: 84.9%, without cancer: 81.8%; Pinteraction = 0.60). 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 = 0.055].
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. This could be a play of chance but warrants further research into the safety and efficacy of rhythm control therapy in patients with a cancer history.
Trial Registration: ClinicalTrials.gov Identifier: NCT01288352
Related
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- Beyond Sinus Rhythm: Rhythm Control and Mechanism-Based Secondary Prevention in Atrial Fibrillation–Related Stroke
BibTeX
@article{ismaili2026early,
title = {{Early rhythm control in patients with atrial fibrillation and cancer: a subgroup analysis of the EAST-AFNET 4 trial}},
author = {Djemail Ismaili and Anna Suling and Katrin Borof and Andreas Goette and Günter Breithardt and A John Camm and Harry Crijns and Lars Eckardt and Arif Elvan and Larissa Fabritz and Isabelle van Gelder and Michele Gulizia and Laurent Haegeli and Hein Heidbuchel and Josef Kautzner and Marc Lemoine and G André Ng and Renate B Schnabel and Lukasz Szumowski and Sakis Themistoclakis and Panos Vardas and Karl Wegscheider and Stephan Willems and Antonia Zapf and Andreas Metzner and Andreas Rillig and Paulus Kirchhof},
journal = {Europace},
year = {2026},
month = sep,
doi = {10.1093/europace/euag269},
url = {https://doi.org/10.1093/europace/euag269},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early rhythm control in patients with atrial fibrillation and cancer: a subgroup analysis of the EAST-AFNET 4 trial
AU - Djemail Ismaili
AU - Anna Suling
AU - Katrin Borof
AU - Andreas Goette
AU - Günter Breithardt
AU - A John Camm
AU - Harry Crijns
AU - Lars Eckardt
AU - Arif Elvan
AU - Larissa Fabritz
AU - Isabelle van Gelder
AU - Michele Gulizia
AU - Laurent Haegeli
AU - Hein Heidbuchel
AU - Josef Kautzner
AU - Marc Lemoine
AU - G André Ng
AU - Renate B Schnabel
AU - Lukasz Szumowski
AU - Sakis Themistoclakis
AU - Panos Vardas
AU - Karl Wegscheider
AU - Stephan Willems
AU - Antonia Zapf
AU - Andreas Metzner
AU - Andreas Rillig
AU - Paulus Kirchhof
PY - 2026
DA - 2026/09/18
JO - Europace
DO - 10.1093/europace/euag269
UR - https://doi.org/10.1093/europace/euag269
AB - 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 and results: 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. Cancer history was available in 2779 of 2789 patients (99.6%). Cancer history was present in 216 of 2779 (7.8%; 19 with active cancer; mean age, 73 years; 95 [44%] women; mean CHA2DS2-VASc score, 3.5). During a follow-up of 8.6 years, early rhythm control reduced the primary outcome in patients with and without a history of cancer (Pinteraction = 0.23) with high rates of sinus rhythm at 24 months (cancer: 84.9%, without cancer: 81.8%; Pinteraction = 0.60). 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 = 0.055]. 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. This could be a play of chance but warrants further research into the safety and efficacy of rhythm control therapy in patients with a cancer history. Trial Registration: ClinicalTrials.gov Identifier: NCT01288352
SN - 1099-5129
SN - 1532-2092
ER -