Article Text

Original research
Eligibility for early rhythm control in patients with atrial fibrillation in the UK Biobank
  1. Shinwan Kany1,2,3,
  2. Victor Roth Cardoso4,5,6,7,
  3. Laura Bravo5,6,7,
  4. John A Williams5,6,7,
  5. Renate Schnabel1,3,
  6. Larissa Fabritz1,3,4,
  7. Georgios V Gkoutos5,6,7,
  8. Paulus Kirchhof1,3,4
  1. 1 Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
  3. 3 Partner site Hamburg/Kiel/Lübeck, German Center for Cardiovascular Sciences (DZHK), Hamburg, Germany
  4. 4 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  5. 5 Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6 Midlands Site, Health Data Research UK, Birmingham, UK
  7. 7 Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Paulus Kirchhof, Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; p.kirchhof{at}


Objective The Early Treatment of Atrial Fibrillation for Stroke Prevention (EAST-AFNET4) trial showed a clinical benefit of early rhythm-control therapy in patients with recently diagnosed atrial fibrillation (AF). The generalisability of the results in the general population is not known.

Methods Participants in the population-based UK Biobank were assessed for eligibility based on the EAST-AFNET4 inclusion/exclusion criteria. Treatment of all eligible participants was classified as early rhythm-control (antiarrhythmic drug therapy or AF ablation) or usual care. To assess treatment effects, primary care data and Hospital Episode Statistics were merged with UK Biobank data.

Efficacy and safety outcomes were compared between groups in the entire cohort and in a propensity-matched data set.

Results AF was present in 35 526/502 493 (7.1%) participants, including 8340 (988 with AF <1 year) with AF at enrolment and 27 186 with incident AF during follow-up. Most participants (22 003/27 186; 80.9%) with incident AF were eligible for early rhythm-control.

Eligible participants were older (70 years vs 63 years) and more likely to be female (42% vs 21%) compared with ineligible patients. Of 9004 participants with full primary care data, 874 (9.02%) received early rhythm-control. Safety outcomes were not different between patients receiving early rhythm-control and controls. The primary outcome of EAST-AFNET 4, a composite of cardiovascular death, stroke/transient ischaemic attack and hospitalisation for heart failure or acute coronary syndrome occurred less often in participants receiving early rhythm-control compared with controls in the entire cohort (HR 0.82, 95% CI 0.71 to 0.94, p=0.005). In the propensity-score matched analysis, early rhythm-control did not significantly decrease of the primary outcome compared with usual care (HR 0.87, 95% CI 0.72 to 1.04, p=0.124).

Conclusion Around 80% of participants diagnosed with AF in the UK population are eligible for early rhythm-control. Early rhythm-control therapy was safe in routine care.

  • Atrial Fibrillation
  • Stroke
  • Catheter Ablation

Data availability statement

Data are available in a public, open access repository. All data are available via the UK Biobank.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available in a public, open access repository. All data are available via the UK Biobank.

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Supplementary materials


  • SK and VRC are joint first authors.

  • Twitter @kany_md, @vrothCardoso

  • Contributors PK, RS, LF and GVG were involved in the idea, planning of the study design, data review and editing the final manuscript; LB and JAW were involved in data analysis and data review; SK and VRC were involved in the idea, planning of the study design, data analysis and creating the manuscript draft and are responsible for the overall content as guarantors.

  • Funding LF and GVG are funded by EU Horizon 2020 MAESTRIA (Grant agreement ID 965286). The Institute of Cardiovascular Research, University of Birmingham, has received an Accelerator Award by the British Heart Foundation AA/18/2/34218. RS has received funding from the European Research Council (early rhythm control) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 648131, from the European Union’s Horizon 2020 research and innovation program under the grant agreement No. 847770 (AFFECT-EU), and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103); German Ministry of Research and Education (BMBF 01ZX1408A); and ERACoSysMed3 (031L0239). PK and LF were partially supported by European Union CATCH ME (grant agreement number 633196) BigData@Heart (grant agreement EU IMI 116074), British Heart Foundation (FS/13/43/30324, PG/17/30/32961 and PG/20/22/35093). PK is partially supported by German Centre for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, via a grant to AFNET), and Leducq Foundation. GVG and VRC also acknowledge support from the National Institute for Health and Care Research (NIHR) Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032) and the MRC Heath Data Research UK (HDRUK/CFC/01), an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Medical Research Council or the Department of Health.

  • Competing interests RS has received lecture fees and advisory board fees from BMS/Pfizer outside this work. LF and PK are listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). LF has received institutional research grants and non-financial support from European Union, DFG, British Heart Foundation, Medical Research Council (UK), National Institute of Health Research NIHR and several biomedical companies. PK receives research support for basic, translational and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK) and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past but not in the last 3 years. All other authors declared no conflict of interest.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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