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Observational Study
. 2025 Mar 3;25(1):35.
doi: 10.1186/s12873-025-01194-z.

Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department

Christian Salbach  1 , Mustafa Yildirim  1 , Hauke Hund  1 , Matthias Müller-Hennessen  1 , Norbert Frey  1 , Hugo Anton Katus  1 , Evangelos Giannitsis  1 , Barbara Ruth Milles  2
Affiliations
Observational Study

Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department

Christian Salbach et al. BMC Emerg Med. .

Abstract

Background: Evidence suggests a benefit of a rhythm control approach in patients with a recent diagnosis of atrial fibrillation (AF). This study sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF) undergoing a non-invasive rhythm control strategy in an emergency department (ED).

Methods: This analysis uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB). HERA-FIB is a retrospective single-centre observational study which consecutively included patients presenting to the ED of the University Hospital of Heidelberg between June 2009 and March 2020 with a sequential follow-up for all-cause mortality, stroke, major bleeding events and myocardial infarction (MI). Outcomes of patients with FDAF were related to treatment strategy (non-invasive rhythm vs. rate control).

Results: Among the 2,758 (27%) patients who presented with FDAF, a non-implementation of a non-invasive rhythm control strategy at admission was observed in 75.4% and associated with an excess of all-cause mortality hazard ratio (HR): 1.61 (95%CI 1.30-1.99), p < 0.0001 and incident MI HR: 1.88 (95% CI 1.22-2.90), p = 0.0043 during follow-up. The non-implementation of a non-invasive rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables with an adjusted HR of 1.52 (95%CI: 1.14-2.04, p = 0.0043) and 1.89 (95%CI: 1.03-3.45, p = 0.0392), respectively.

Conclusion: Real-world data from FDAF patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis.

Trial registration: The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.

Keywords: Atrial fibrillation; First diagnosed atrial fibrillation; Non-invasive rhythm control; Real-world evidence.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of the University of Heidelberg (S-377/2013). Since this study involves no patients and uses data from clinical routine care, a consent to participate declaration was not applicable. Consent for publication: Not applicable. Competing interests: Competing interests MMH received research funding from BRAHMS, Thermo Fisher Scientific and Roche Diagnostics. EG received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer, Daiichi-Sankyo, Lilly Eli Deutschland. He serves as a consultant for Roche Diagnostics, BRAHMS Thermo Fisher Scientific, Boehringer Ingelheim and has received research funding from BRAHMS Thermo Fisher Scientific, Roche Diagnostics, Bayer Vital and Daiichi Sankyo. NF has received speaker honoraria from Daiichi Sankyo, Astra Zeneca, Boehringer Ingelheim and Bayer Vital. He serves as a consultant for ZOLL CMS. BRM, received research funding from Daiichi Sankyo. There are no disclosures for HAK, MY, HH and CS.

Figures

Fig. 1
Fig. 1
Flow chart of in- and excluded patients. The diagram shows included and excluded patients after removing repeated visits, visits without AF, re-adjudication of the diagnosis, adjudication of follow-up and exclusion of patients with pre-existing AF. Abbreviations: AF, atrial fibrillation; ED, emergency department
Fig. 2
Fig. 2
Kaplan Meier analysis for cardiovascular events in FDAF patients stratified by non-invasive rhythm control strategy for all-cause mortality (A), stroke (B), major bleeding events (C) and myocardial infarction (D). Abbreviations: FDAF, first diagnosed atrial fibrillation; MI, myocardial infarction
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