{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:03:45Z","timestamp":1789747425032,"version":"4.0.1"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Early rhythm-control improves cardiovascular outcomes in patients with atrial fibrillation (AF). Its effectiveness in patients with cancer is unclear. This study evaluated the effects of cancer history on early rhythm-control in the EAST-AFNET 4 trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of EAST-AFNET 4 compared patients with and without a history of cancer, including active cancer and cancer in remission. Outcomes included the primary outcome, a composite of cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome; the safety outcome, a composite of death, stroke, and serious adverse events related to rhythm-control; and rhythm at 24 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cancer history was available in 2779\/2789 patients (99.6%). Cancer history was present in 216\/2779 (7.8%; 19 with active cancer; mean age, 73 years; 95 [44%] women; mean CHA2DS2-VASc score, 3.5). During a follow-up to 8.6 years, early rhythm control reduced the primary outcome in patients with and without a history of cancer (pinteraction = .23) with high rates of sinus rhythm at 24 months (cancer: 84.9%, without cancer: 81.8%; pinteraction = .60). In patients with a cancer history, there was a signal for more safety outcomes with early rhythm control (early rhythm control 36\/116 [31%] patients with event, 22 deaths; usual care 20\/100 [20%] patients with event, 18 deaths; pinteraction = .055).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early rhythm control therapy appears effective in patients with AF and a history of cancer but may be less safe than in patients without cancer, in this hypothesis-generating analysis. This could be play of chance but warrants further research into the safety and efficacy of rhythm control therapy in patients with a cancer history.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag269","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:20:06Z","timestamp":1789672806000},"source":"Crossref","is-referenced-by-count":0,"title":["Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8709-0448","authenticated-orcid":false,"given":"Djemail","family":"Ismaili","sequence":"first","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Department of Cardiology , Hamburg ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK) , partner site Hamburg\/Kiel\/L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8537-1948","authenticated-orcid":false,"given":"Anna","family":"Suling","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Borof","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Department of Cardiology , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8223-7209","authenticated-orcid":false,"given":"Andreas","family":"Goette","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Paderborn, Germany, Otto-von-Guericke University, Medical Faculty , Magdeburg , , MAESTRIA consortium","place":["Germany"]},{"name":"Atrial Fibrillation NETwork (AFNET) , Mendelstr. 11, 48149 M\u00fcnster ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7574-8900","authenticated-orcid":false,"given":"G\u00fcnter","family":"Breithardt","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation NETwork (AFNET) , Mendelstr. 11, 48149 M\u00fcnster ,","place":["Germany"]},{"name":"Department of Cardiology and Angiology, University Hospital M\u00fcnster ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-2871","authenticated-orcid":false,"given":"A John","family":"Camm","sequence":"additional","affiliation":[{"name":"Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, City St. George\u2019s University of London , Cranmer Terrace, London SW17 0RE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1073-5337","authenticated-orcid":false,"given":"Harry","family":"Crijns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University , Maastricht ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3735-8503","authenticated-orcid":false,"given":"Lars","family":"Eckardt","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation NETwork (AFNET) , Mendelstr. 11, 48149 M\u00fcnster ,","place":["Germany"]},{"name":"Department of Cardiology and Angiology, University Hospital M\u00fcnster 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Kingdom"]},{"name":"University Center of Cardiovascular Sciences, UKE , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-1201","authenticated-orcid":false,"given":"Isabelle","family":"van Gelder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Gulizia","sequence":"additional","affiliation":[{"name":"Cardiology Division, Garibaldi-Nesima Hospital , Catania ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Haegeli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart Centre, University Hospital Zurich , Zurich 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Cardiology , Hamburg ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK) , partner site Hamburg\/Kiel\/L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5965-0671","authenticated-orcid":false,"given":"G Andr\u00e9","family":"Ng","sequence":"additional","affiliation":[{"name":"British Heart Foundation Leicester Centre of Research Excellence, NIHR Leicester Biomedical Research Centre, Division of Cardiovascular Sciences, University of Leicester ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7170-9509","authenticated-orcid":false,"given":"Renate B","family":"Schnabel","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Department of Cardiology , Hamburg ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK) , partner site Hamburg\/Kiel\/L\u00fcbeck 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