AFFIRM

Atrial Fibrillation Follow-up Investigation of Rhythm Management

Patient / Population Intervention / Exposure Comparison Outcome

In 4,060 patients with AF at high risk of stroke, a rhythm-control strategy did not reduce all-cause mortality compared with rate control.

4,060

Design

RCT, mean 3.5 yr

Endpoint

All-cause mortality

Relevance

Result23.8% vs 21.3% (HR 1.15, 95% CI 0.99–1.34, P=0.08). Trend favouring rate control.

AFFIRM Investigators. N Engl J Med. 2002;347(23):1825-1833. 10.1056/NEJMoa021328

Discussion & critique

Era of class IC/III drugs, no ablation arm. EAST-AFNET 4 (2020) re-opened the question for early AF with modern strategies.