Patients with an acute stroke and atrial fibrillation have a particularly high risk of a recurrent stroke and other serious cardiovascular events. A Europe-wide clinical trial led by scientists from the University Medical Centre Hamburg-Eppendorf (UKE) is now investigating whether early rhythm-control treatment can effectively and safely prevent strokes. The EU is funding the project with seven million euros over the next six years.
In the international EAST-STROKE (‘Early treatment of Atrial fibrillation for Stroke prevention Trial in acute STROKE’) trial, patients with atrial fibrillation and an acute ischaemic stroke receive early rhythm-control therapy in addition to the usual stroke and atrial fibrillation treatment. This involves treatment with antiarrhythmic drugs, cardioversion and, in individual cases, atrial fibrillation ablation. These treatments can normalise the irregular heartbeat of those affected. Preliminary findings suggest that rhythm control can prevent strokes and other cardiovascular events. This treatment, which is already established in atrial fibrillation therapy, has rarely been used in acute stroke patients due to the potential risks and side effects. ‘If the study confirms the results of our preliminary analysis, it could change clinical practice in the treatment of stroke patients with atrial fibrillation worldwide and help prevent many thousands of new strokes,’ says project coordinator Prof Dr Götz Thomalla, Director of the Department of Neurology at the UKE.
No increased complication rate after a previous stroke
The study is primarily based on preliminary work by UKE scientists. In the EAST-AFNET 4 study led by Prof Dr Paulus Kirchhof, Atrial Fibrillation Network (AFNET) and Department of Cardiology at the UKE, the benefits of early rhythm-control therapy in patients with atrial fibrillation were demonstrated four years ago. Three years later, Dr Märit Jensen, Clinic and Polyclinic for Neurology at the UKE, was able to show that this treatment is particularly beneficial and safe in the subgroup of patients with atrial fibrillation and a history of stroke. In the trial now starting, rhythm-control therapy will be initiated shortly after the acute stroke. ‘The study is an excellent example of cooperation between cardiology and neurology in the innovative treatment of patients with stroke,’ says Prof Kirchhof, co-coordinator of the study.
EAST-STROKE is being funded by the EU as part of ‘Horizon Europe’ and is initially being started in 42 clinics in Germany, Spain, Switzerland and the Netherlands; the participation of other countries is planned in the course of the programme. A total of 1746 patients will be included in the study, which is scheduled to start at the beginning of 2025. ‘The plan for EAST-STROKE has already met with a great response. Partner studies are currently being prepared in an international collaboration in Australia, Brazil and the USA, among others,’ says study coordinator Dr Märit Jensen.
