When the future of rhythm control therapy is discussed, the EAST – AFNET 4 trial is often mentioned together with CABANA.

The two studies have important commonalities: Both studies base their hypothesis on the assumption that catheter
ablation provides better rhythm control therapy
than the therapies that were tested in AFFIRM,
RACE, and other earlier trials using antiarrhythmic
drug therapy alone. Both share a composite
outcome of cardiovascular events, in our trial
mainly of cardiovascular death, stroke, heart

failure, and myocardial infarction. Both trials are expected to present their final reports in the next few years and the trials’ leaderships plan joint analyses of their data sets after having reported individually.

On the other hand, there are also important differences:
CABANA only enrolls patients who need
rhythm control therapy and randomizes these
patients to either antiarrhythmic drug therapy or
catheter ablation. Therefore, CABANA will provide
answers to the best rhythm control therapy in
patients with symptomatic AF.

EAST – AFNET 4 in contrast, randomizes patients with recently diagnosed AF to either usual care (mainly rate control therapy without rhythm control therapy) or
rhythm control therapy. Therefore by conducting
EAST – AFNET 4, we will provide much-needed
information on the prognostic value of rhythm
control therapy.