{"id":"811e870fa294","type":"article","url":"https://hartvaat.nl/2024/06/03/east-afnet-4-natriumkanaalblokkers-veilig-en-effectief-voor-langetermijn-ritmeco/","title":"EAST-AFNET 4: natriumkanaalblokkers veilig en effectief voor langetermijn ritmecontrole","title_en":"Safety and efficacy of long-term sodium channel blocker therapy for early rhythm control: the EAST-AFNET 4 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euae121","source_url":"https://doi.org/10.1093/europace/euae121","authors":["Andreas Rillig","Lars Eckardt","Katrin Borof","A John Camm","Harry J G M Crijns","Andreas Goette","Günter Breithardt","Marc D Lemoine","Andreas Metzner","Laura Rottner","Ulrich Schotten","Eik Vettorazzi","Karl Wegscheider","Antonia Zapf","Hein Heidbuchel","Stephan Willems","Larissa Fabritz","Renate B Schnabel","Christina Magnussen","Paulus Kirchhof"],"significance":7,"published":"2024-06-03","source_date":"2024-06-03","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"This EAST-AFNET 4 analysis confirmed that sodium channel blockers (flecainide, propafenone) are safe and effective for long-term early rhythm control in AF patients with cardiovascular comorbidities, addressing concerns about proarrhythmic effects.","created":"2026-07-03T10:30:58Z","updated":"2026-07-03T13:30:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse van EAST-AFNET 4 bevestigde dat natriumkanaalblokkers (flecaïnide, propafenon) veilig en effectief zijn als onderdeel van vroege ritmecontrole bij AF. Het CV-voordeel bleef behouden zonder veiligheidssignalen.","abstract_original":"AIMS: Clinical concerns exist about the potential proarrhythmic effects of the sodium channel blockers (SCBs) flecainide and propafenone in patients with cardiovascular disease. Sodium channel blockers were used to deliver early rhythm control (ERC) therapy in EAST-AFNET 4. METHODS AND RESULTS: We analysed the primary safety outcome (death, stroke, or serious adverse events related to rhythm control therapy) and primary efficacy outcome (cardiovascular death, stroke, and hospitalization for worsening of heart failure (HF) or acute coronary syndrome) during SCB intake for patients with ERC (n = 1395) in EAST-AFNET 4. The protocol discouraged flecainide and propafenone in patients with reduced left ventricular ejection fraction and suggested stopping therapy upon QRS prolongation >25% on therapy. Flecainide or propafenone was given to 689 patients [age 69 (8) years; CHA2DS2-VASc 3.2 (1); 177 with HF; 41 with prior myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention; 26 with left ventricular hypertrophy >15 mm; median therapy duration 1153 [237, 1828] days]. The primary efficacy outcome occurred less often in patients treated with SCB [3/100 (99/3316) patient-years] than in patients who never received SCB [SCBnever 4.9/100 (150/3083) patient-years, P < 0.001]. There were numerically fewer primary safety outcomes in patients receiving SCB [2.9/100 (96/3359) patient-years] than in SCBnever patients [4.2/100 (135/3220) patient-years, adjusted P = 0.015]. Sinus rhythm at 2 years was similar between groups [SCB 537/610 (88); SCBnever 472/579 (82)]. CONCLUSION: Long-term therapy with flecainide or propafenone appeared to be safe in the EAST-AFNET 4 trial to deliver effective ERC therapy, including in selected patients with stable cardiovascular disease such as coronary artery disease and stable HF. Clinical Trial Registration ISRCTN04708680, NCT01288352, EudraCT2010-021258-20, www.easttrial.org."}