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Atrial Fibrillation (AF) is the most common arrhythmia of the heart. It affects almost 2 million people in Germany. The German competence Network on Atrial Fibrillation (AFNET) aims at investigating the reasons and mechanisms of this arrhythmia and improving care of patients with atrial fibrillation. On 1st March 2013, the network celebrates its 10-year anniversary.
Atrial fibrillation is not directly life-threatening. But it leads to severe complications such as stroke. In order to look scientifically into this widespread disease and to improve care, the AFNET was founded in 2003 and has since then been funded by the German Federal Ministry of Research and Education (BMBF) with 17 million Euros. AFNET consists of a network of 600 physicians and scientists. About 20 clinical trials, registries, and basic research projects have been performed so far.
The chairman of the AFNET board, Prof. Günter Breithardt, Münster, Germany, takes stock of 10 years of networking: “During these 10 years we have gained a better understanding of AF and its severest complication, namely stroke. The new findings have a strong impact on the management of our patients. And we learnt how patients are treated within our health care system. Thereby, we revealed some shortcomings. I am optimistic that the therapy guidelines which are based on such research will increasingly be put into practice. Nevertheless, we will have to cope with many challenges to face the widespread disease atrial fibrillation.”
The AFNET follows a comprehensive research approach integrating basic science, healthcare research, and clinical trials. Between 2004 and 2006 the AFNET enrolled 10,000 patients coming from all levels of care into a registry. Since that time patients have been followed-up for more than 5 years. The registry data revealed that the management of AF is predominantly performed according to the guidelines. However, there has been significant under-treatment in stroke prevention. Not all patients at high risk for stroke have received an adequate antithrombotic therapy. The follow-up data which are currently being analyzed promise manifold findings on the complications of AF during a very long follow-up. Three large multicenter clinical trials have been performed and completed by the network of hospitals and private practices: ANTIPAF – AFNET 2 tested the efficacy of Angiotensin receptor blockers in paroxysmal atrial fibrillation, Gap-AF – AFNET 1 the need of complete pulmonary vein isolation in catheter ablation. Flec-SL – AFNET 3 assessed the benefit of a short-term antiarrhythmic drug treatment for 4 weeks after cardioversion which has turned out to be nearly as efficient as the usual long-term treatment. The results of these trials were incorporated into the European guidelines for the management of atrial fibrillation. Basic research projects succeeded in explaining molecular-biological and genetic mechanisms of AF building the basis of the clinical trials performed within the AFNET.
While the AFNET was originally founded as a national network, current studies and projects are designed internationally. The pan-European EAST – AFNET 4 trial, started in July 2011, is conducted jointly by AFNET and the European Heart Rhythm Association (EHRA). This study is to test whether an early and comprehensive rhythm control treatment of patients with early onset AF leads to better patient outcomes than usual care alone. In the field of basic pathophysiological research, AFNET scientists continue their cooperation within the „European/North-American atrial fibrillation research alliance (ENAFRA)“ and the „European network for translational research in atrial fibrillation (EUTRAF)“, in the field of genetics within the „CHARGE-AF Genome-wide association study“. The AFNET long-term experience in clinical registries will also be incorporated into European large-scale projects.Since 2007, AFNET and EHRA organize joint consensus conferences in which AF specialists from Europe and North America pool their knowledge and define recommendations. The 4th of these experts’ summits has taken place in January 2013. The results are just being prepared for publication. Additionally, AFNET scientists contributed to the development of the current European guidelines for the management of AF.
On the occasion of the 10-year anniversary, members of the AFNET, its supporters, friends, and guests will assemble in the historic Langenbeck-Virchow-Haus close to Charité in Berlin. The ceremony on the 28th February 2013 will be followed by a scientific symposium on 1st March 2013. Location: Langenbeck-Virchow-Haus, Luisenstraße 58/59, 10117 Berlin, Germany Program available here.
AFNET clinical trialsGap-AF – AFNET 1: Catheter ablation of atrial fibrillation by linear PV isolation (NCT00293943)ANTIPAF – AFNET 2: Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation Trial (NCT00098137)Flec-SL – AFNET 3: Flecainide short-long trial: Targeted Pharmacological Reversal of Electrical Remodeling after Cardioversion. (NCT00215774, ISRCTN62728743)EAST – AFNET 4: Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (NCT01288352, ISRCTN04708680)
AFNET Board of DirectorsProf. Dr. med. Dr. h.c. Günter Breithardt, MünsterProf. Dr. med. Paulus Kirchhof, Münster / Birmingham, UKProf. Dr. med. Michael Näbauer, MünchenProf. Dr. med. Gerhard Steinbeck, München