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

## TL;DR

This study shows that using a non-invasive rhythm control strategy for first-time atrial fibrillation patients in emergency departments is linked to better outcomes, including lower mortality and fewer heart attacks.

## Contribution

The study provides real-world evidence that non-invasive rhythm control improves outcomes in first-diagnosed atrial fibrillation patients compared to rate control.

## Key findings

- Non-invasive rhythm control was associated with a 61% lower risk of all-cause mortality.
- Patients with non-invasive rhythm control had an 88% lower risk of myocardial infarction.
- The benefit of rhythm control remained significant after adjusting for other variables.

## Abstract

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).

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).

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.

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.

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

The online version contains supplementary material available at 10.1186/s12873-025-01194-z.