Early rhythm control therapy reduces cardiovascular complications compared to usual care in patients with atrial fibrillation and a high comorbidity burden (CHA2DS2-VASc score ≥4). These patients should preferentially be treated with early rhythm control to protect them from cardiovascular outcomes. This is the result of a subgroup analysis of the EAST – AFNET 4 trial that was presented by Dr. Andreas Rillig, University Heart and Vascular Center Hamburg-Eppendorf, Germany, at the Heart Rhythm congress in San Francisco, USA, on 29.04.2022 [1], [2].