Early rhythm control has been suggested as a strategy to improve outcomes in patients with atrial fibrillation (AF), although evidence from large real-world cohorts remains limited. An analysis from the GLORIA-AF Registry phase III evaluated the use and outcomes of rhythm control in patients with recently diagnosed AF. The analysis was published in the Journal of the American Heart Association. 

The study included patients enrolled in the registry with newly diagnosed AF. Rhythm control at baseline included treatment with antiarrhythmic drugs or prior catheter ablation or cardioversion. Patients who did not receive these therapies were classified in the no rhythm control group. Multivariable regression analyses examined factors associated with rhythm control use. The models also evaluated oral anticoagulant therapy and major clinical outcomes. The primary outcome was a composite of all-cause death and major adverse cardiovascular events.

Among 21,051 patients with AF (mean age 70.2±10.3 years; 45% women), rhythm control therapy was used in 6,932 patients (32.9%). Older age, more sustained AF forms, and a history of thromboembolism were associated with lower likelihood of rhythm control. Use of oral anticoagulants was more common among patients receiving rhythm control (odds ratio 1.36; 95% CI 1.25–1.48).

During a 3-year follow-up, rhythm control was associated with a lower risk of the primary composite outcome (hazard ratio 0.88; 95% CI 0.80–0.96). Similar associations were observed for secondary outcomes, including all-cause death, thromboembolism, and major bleeding.
In this real-world registry cohort, rhythm control therapy was used in about one-third of patients with recently diagnosed AF. Rhythm control was associated with greater use of oral anticoagulation and lower risk of major clinical outcomes.