atrial fibrillation af
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting over 33 million people worldwide and conferring a fivefold increased risk of stroke. Clinical trials in AF address three core problems: rhythm control (restoring and maintaining sinus rhythm), rate control (controlling heart rate in persistent AF), and stroke prevention (anticoagulation). The EAST-AFNET 4 trial established early rhythm control as superior to a rate-control strategy in reducing cardiovascular events, reshaping international guidelines.
Current trials evaluate non-vitamin K oral anticoagulants (NOACs) in underserved populations, pulse field ablation versus radiofrequency ablation (ADVENT trial showed non-inferiority), left atrial appendage occlusion devices (WATCHMAN FLX) versus NOAC therapy in patients with bleeding risk, and novel antiarrhythmic drugs with improved safety profiles. Digital health trials using smartwatch-detected AF episodes are emerging as enrollment and monitoring tools.
CHAβ‚‚DSβ‚‚-VASc score determines anticoagulation eligibility; prior ablation history and type of AF (paroxysmal, persistent, long-standing persistent) determine eligibility for rhythm control trials.