{"id":"45c40c351679","type":"article","url":"https://hartvaat.nl/2026/11/24/vroege-ritmecoordinatie-verlaagt-recidief-beroerte-bij-atriumfibrilleren-na-isch/","title":"Vroege ritmecoördinatie verlaagt recidief beroerte bij atriumfibrilleren na ischemische beroerte — DeSC-IQVIA","title_en":"Early Rhythm Control vs Usual Care After Acute Ischemic Stroke in Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"Neurology","doi":"10.1212/WNL.0000000000218736","source_url":"https://doi.org/10.1212/WNL.0000000000218736","authors":["Shuhei Egashira","Kosuke Inoue","Masatoshi Koga","Kazunori Toyoda","Märit Jensen","Götz Thomalla","Tatsushi Toda","Yuichi Imanaka"],"significance":5,"published":"2026-10-30","source_date":"2026-11-24","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"In a nationwide Japanese cohort of 14,355 patients surviving acute ischemic stroke with atrial fibrillation, early rhythm control within eight weeks was associated with a significantly lower risk of recurrent stroke or systemic embolism compared to usual care (HR 0.56; 5-year cumulative incidence 8.0% vs 13.8%). All-cause mortality was also reduced (HR 0.72), with no significant increase in major bleeding. While these observational findings support early rhythm control as a potential secondary prevention strategy, randomized trials are needed to confirm efficacy and safety before routine adoption.","created":"2026-10-24T01:04:23Z","updated":"2026-10-24T01:04:23Z","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":"In een Japanse cohortstudie onder 14.355 patiënten die overleefden zonder complicaties na een acute ischemische beroerte, werd vroege ritmecoördinatie (binnen 8 weken) vergeleken met gebruikelijke zorg. Patiënten die vroege ritmecoördinatie ontvingen hadden een lager risico op recidief ischemische beroerte of systemische embolie (HR 0,56; cumulatieve incidentie na 5 jaar 8,0% versus 13,8%). Ook het overlijdensrisico was lager (HR 0,72), zonder toename van bloedingen. Deze bevindingen suggereren dat vroege ritmecoördinatie een waardevolle secundaire preventiestrategie kan zijn, maar bevestiging in gerandomiseerde trials is noodzakelijk voordat het routinematig wordt toegepast.","abstract_original":"BACKGROUND AND OBJECTIVES: Early rhythm control reduces cardiovascular events in patients with atrial fibrillation (AF); however, its effectiveness in the setting of acute ischemic stroke remains uncertain. We aimed to examine whether early rhythm control after acute ischemic stroke is associated with a lower risk of recurrent stroke or systemic embolism (SE) in patients with AF. METHODS: This nationwide cohort study used the DeSC-IQVIA integrated database, an administrative claims database covering approximately 16 million individuals in Japan. Adults hospitalized for acute ischemic stroke with AF present at admission between 2014 and 2025 were included. The exposure was initiation of rhythm control (antiarrhythmic drugs, catheter ablation, or electrical cardioversion) within 8 weeks of admission (early rhythm control) vs no initiation (usual care), assessed at a landmark. The primary outcome was hospitalization for recurrent ischemic stroke or SE. Secondary outcomes included major bleeding, heart failure (HF) hospitalization, and all-cause mortality. Baseline differences were adjusted using propensity score overlap weighting. Cause-specific hazard ratios (HRs), cumulative incidence with death as a competing risk, and risk differences at 5 years were estimated. RESULTS: Among 14,355 patients who survived event-free through the 8-week landmark (median age, 83 years [IQR, 78-88]; 6,935 [48.3%] women), 268 (1.9%) received early rhythm control. During 23,583 person-years, early rhythm control was associated with a lower risk of stroke/SE (HR, 0.56; 95% CI 0.32-0.97; weighted 5-year cumulative incidence, 8.0% vs 13.8%; risk difference, -5.9 percentage points [95% CI -11.0 to 0.8]). Among secondary outcomes, no association was observed with major bleeding (HR, 1.44; 95% CI 0.74-2.82) or HF hospitalization (HR, 0.73; 95% CI 0.39-1.38); early rhythm control was associated with lower all-cause mortality (HR, 0.72; 95% CI 0.53-0.97). Results were consistent across landmark periods of 4-24 weeks. DISCUSSION: In this nationwide cohort study, early rhythm control after acute ischemic stroke in patients with AF was associated with a reduced risk of recurrent stroke or SE. These findings suggest that early rhythm control may serve as an additional secondary prevention strategy for ischemic stroke, with flexible timing of initiation. These observational findings are hypothesis-generating and warrant confirmation in randomized controlled trials."}