2025OPTIONLAAOIn 1,600 patients with atrial fibrillation who underwent catheter ablation, left atrial appendage closure was non-inferior for death, stroke, or systemic embolism and reduced bleeding compared with oral anticoagulation.
2025OCEANIC-AFfactor XIa inhibitorIn 14,810 patients with atrial fibrillation at high stroke risk, asundexian was inferior for prevention of stroke or systemic embolism compared with apixaban.
2024ARTESiADOACIn 4,012 patients with device-detected subclinical AF and stroke risk factors, apixaban reduced stroke or systemic embolism compared with aspirin, at the cost of more bleeding.
2024FRAIL-AFDOAC switchIn 1,330 frail elderly patients with atrial fibrillation stable on a vitamin K antagonist, switching to a DOAC increased major or clinically relevant bleeding compared with continuing the vitamin K antagonist.
2024SHAM-PVIAblationIn 126 patients with symptomatic paroxysmal or persistent atrial fibrillation, cryoballoon pulmonary vein isolation reduced atrial fibrillation burden at 6 months compared with a sham procedure.
2023ADVENTAblationIn 607 patients with paroxysmal AF, pulsed-field ablation was non-inferior to conventional thermal ablation for treatment success and safety.
2023NOAH-AFNET 6DOACIn 2,536 patients with device-detected atrial high-rate episodes, edoxaban did not reduce cardiovascular death, stroke, or systemic embolism compared with placebo.
2021EARLY-AFAblationIn 303 patients with paroxysmal AF, first-line cryoballoon ablation reduced atrial arrhythmia recurrence compared with antiarrhythmic drugs.
2021LAAOS IIIsurgical LAAOIn 4,660 patients with atrial fibrillation undergoing cardiac surgery, surgical left atrial appendage occlusion reduced ischaemic stroke or systemic embolism compared with no occlusion.
2020EAST-AFNET 4Rate vs rhythmIn 2,789 patients with early AF (≤ 1 yr), early rhythm-control therapy reduced CV death, stroke or hospitalisation for HF or ACS versus usual care.
2020PRAGUE-17LAAOIn 402 high-risk patients with non-valvular atrial fibrillation, percutaneous left atrial appendage closure was non-inferior for a composite of cardiovascular and bleeding events compared with direct oral anticoagulants.
2019CABANAAblationIn 2,204 patients with symptomatic atrial fibrillation, catheter ablation did not significantly reduce death, disabling stroke, serious bleeding, or cardiac arrest compared with antiarrhythmic drug therapy.
2018CASTLE-AFAblationIn 363 patients with AF and heart failure with reduced ejection fraction, catheter ablation reduced death or heart-failure hospitalisation compared with medical therapy.
2016FIRE AND ICEAblationIn 762 patients with drug-refractory paroxysmal atrial fibrillation, cryoballoon ablation was non-inferior for clinical treatment failure compared with radiofrequency ablation.
2015STAR AF IIAblationIn 589 patients with persistent atrial fibrillation, adding complex electrogram or linear ablation did not improve freedom from AF recurrence compared with pulmonary-vein isolation alone.
2014PROTECT AFLAAOIn 707 patients with non-valvular atrial fibrillation eligible for warfarin, Watchman left atrial appendage closure was non-inferior for stroke, systemic embolism, or cardiovascular death compared with warfarin.
2014CRYSTAL AFcardiac monitorIn 441 patients with recent cryptogenic stroke, an insertable cardiac monitor detected atrial fibrillation more often than conventional follow-up.
2013ENGAGE AF-TIMI 48AnticoagulationIn 21,105 patients with AF at moderate-to-high stroke risk, edoxaban was non-inferior to warfarin for stroke or systemic embolism, with less bleeding.
2011ROCKET-AFAnticoagulationIn 14,264 patients with non-valvular AF at moderate-high stroke risk, rivaroxaban was non-inferior to warfarin for stroke or systemic embolism, with less intracranial bleeding.
2011ARISTOTLEAnticoagulationIn 18,201 patients with AF and ≥ 1 stroke risk factor, apixaban reduced stroke or systemic embolism, major bleeding and all-cause mortality compared with warfarin.
2010RACE IIrate controlIn 614 patients with permanent atrial fibrillation, lenient rate control (resting heart rate <110 bpm) was non-inferior for a composite of cardiovascular events compared with strict rate control.
2009RE-LYAnticoagulationIn 18,113 patients with non-valvular AF, dabigatran 150 mg twice daily reduced stroke or systemic embolism compared with warfarin, with similar major bleeding.
2002AFFIRMRate vs rhythmIn 4,060 patients with AF at high risk of stroke, a rhythm-control strategy did not reduce all-cause mortality compared with rate control.
1991SPAFantithromboticIn 1,330 patients with non-rheumatic atrial fibrillation, warfarin and aspirin each reduced ischaemic stroke or systemic embolism compared with placebo.