Early Rhythm Control May Cut Recurrent Stroke Risk in AF

TOPLINEEarly rhythm control therapy initiated within 8 weeks of admission for acute ischemic stroke in patients with atrial fibrillation (AF) was associated with a reduced risk for recurrent ischemic stroke or systemic embolism (SE) compared with usual care, a study showed.METHODOLOGYResearchers conducted a nationwide retrospective cohort study using the DeSC-IQVIA integrated claims database in Japan from 2014 to 2025.A total of 14,355 adults hospitalized for acute ischemic stroke with AF present at admission (median age, 83 years; 48.3% women) were included.At 8 weeks, patients were classified as having received early rhythm control therapy (antiarrhythmic drugs, catheter ablation, or electrical cardioversion initiated within 8 weeks of admission; n = 268) or usual care (no rhythm control therapy; n = 14,087).Researchers primarily assessed hospitalization for recurrent ischemic stroke or SE.They also assessed major bleeding, heart failure (HF) hospitalization, and all-cause mortality.TAKEAWAYEarly rhythm control therapy was linked to a lower risk for recurrent stroke or SE (hazard ratio [HR], 0.56; 95% CI, 0.32-0.97; weighted 5-year cumulative incidence, 8.0% vs 13.8%; risk difference, -5.9 percentage points [95% CI, -11.0 to 0.8]).Early rhythm control therapy was not linked to major bleeding or HF hospitalization.Early rhythm control therapy was linked to lower all-cause mortality (HR, 0.72; 95% CI, 0.53-0.97; weighted 5-year cumulative incidence, 24% vs 40%; risk difference, -15.9 percentage points [95% CI, -23.6 to -8.6]).Results remained consistent across alternative landmark periods of 4, 12, and 24 weeks, and subgroup analyses suggested more pronounced risk reduction among patients without intracranial or extracranial artery stenosis (HR, 0.36; 95% CI, 0.17-0.76).IN PRACTICE"People who have an ischemic stroke are prescribed anticoagulants, medications that stop the blood from clotting easily, to prevent a second stroke. Our study suggests that early rhythm control may serve as another prevention strategy, with flexible timing of initiation, within eight weeks of stroke," corresponding investigator Yuichi Imanaka, MD, MPH, PhD, Kyoto University, Japan, said in a press release.SOURCEThe study was led by Shuhei Egashira, Graduate School of Medicine, Kyoto University, Japan. It was published online on October 21 in Neurology.LIMITATIONSThe early rhythm control group was small, limiting precision for long-term outcomes. Treatment crossover and time-dependent confounding after the landmark were not fully addressed. Important clinical variables such as stroke severity, functional status, imaging findings, echocardiographic parameters, and AF burden were unavailable in the claims data. Residual confounding from unmeasured factors could not be fully excluded. Adverse effects of rhythm control could not be reliably ascertained, and coding errors or misclassification of AF type were possible. Additionally, the cohort included predominantly older Japanese adults, limiting the generalizability of the findings.DISCLOSURESThe study was funded by the Japan Society for the Promotion of Science. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.