EAST-AFNET 4 asked whether early rhythm control beats usual care on cardiovascular death, stroke, heart-failure hospitalization, or ACS. Over a median 5.1 years the event rate was 3.9 vs 5.0 per 100 person-years (HR 0.79). Most early rhythm control was medication, not ablation.
AVANT-GUARD asked whether first-line PFA beats first-line drugs on keeping sinus rhythm in untreated persistent AFib. Success at 12 months was 56% vs 30%, with continuous monitoring.
EAST changed when to chase rhythm. AVANT-GUARD changes what you may offer first once AFib is already persistent. They should not be cited as the same trial with a newer catheter.