Rhythm Control in Patients With Recently Diagnosed Atrial Fibrillation: Findings From the GLORIA-AF Registry Phase III

Background: Early rhythm control has been proposed to improve outcomes in patients with atrial fibrillation (AF), but data on its effectiveness in real-world cohorts remain limited. We aimed to evaluate the effectiveness of rhythm control in patients with recently diagnosed AF. Methods: We included patients with recently diagnosed AF enrolled in the GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) registry phase III. We analyzed rhythm control at baseline, defined as treatment with an antiarrhythmic drug, or having received AF ablation or cardioversion; patients who did not receive any of these treatments were assigned to the "no rhythm control" group. We analyzed factors associated with rhythm control, treatment with an oral anticoagulant, and risk of major outcomes using multivariable regression analyses. The primary outcome for this analysis was the composite of all-cause death and major adverse cardiovascular events. Results: Of 21 051 patients with AF included in this analysis (mean age, 70.2±10.3 years, 45% women), 6932 (32.9%) received rhythm control. Older age, more sustained forms of AF, and history of thromboembolism were associated with no rhythm control at baseline; conversely, oral anticoagulants were more likely used in patients receiving rhythm control (odds ratio, 1.36 [95% CI, 1.25-1.48]). During 3-year follow-up, rhythm control was associated with lower hazard of the primary composite outcome (hazard ratio, 0.88 [95% CI, 0.80-0.96]). Similar results were observed for other secondary outcomes, including all-cause death, thromboembolism, and major bleeding. Conclusions: In this real-world cohort of patients with AF, rhythm control was used in 1 of 3 patients, and was associated with higher use of oral anticoagulants and better outcomes.