Key result
Rhythm control fails to shorten hospital stay versus rate control in post-cardiac surgery AF.
Why the study?
The clinical impact of a rhythm control strategy compared to a rate control strategy in patients with postcardiac surgery atrial fibrillation remained to be determined.
Does a rhythm control strategy reduce hospital length of stay in adult patients with new-onset postoperative atrial fibrillation after cardiac surgery compared to a rate control strategy?
Meta-Analysis (n=894)
Does a rhythm control strategy reduce hospital length of stay in adult patients with new-onset postoperative atrial fibrillation after cardiac surgery compared to a rate control strategy?
Mean Difference: -0.41 (95% CI -3.23–2.42)
p-value: p=0.78
A rhythm control strategy for postoperative atrial fibrillation after cardiac surgery does not improve hospital length of stay compared to rate control, and aggressive rhythm control may increase medication-related adverse events.
Background We aimed to compare the clinical impact of treatment with a rhythm control strategy to a rate control strategy in postcardiac surgery atrial fibrillation patients. Methods A comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and ClinicalTrials.gov was conducted from inception to October 2025. Our meta-analysis included randomized controlled trials (RCTs) comparing therapeutic rhythm control interventions with rate control interventions. We used the Cochrane risk-of-bias tool to appraise the quality of included RCTs, the GRADE framework to evaluate the strength of the evidence, and adhered to the PRISMA guidelines for reporting. Results Eight RCTs ( n = 894 patients) met the inclusion criteria. There was no difference in hospital length of stay (4 RCTs) between rhythm control and rate control [MD: −0.41 days (95% CI: −3.23, 2.42)]. An aggressive rhythm control strategy (ibutilide, procainamide, propafenone, or electric cardioversion) was associated with higher odds of in-hospital conversion to sinus rhythm [OR: 4.01 (95% CI: 1.30, 12.39)] and a higher risk of medication-related adverse events (hypotension, bradycardia, and syncope) [RR: 3.05 (95% CI: 1.05, 8.89)]. Conclusion Among postcardiac surgery patients with new-onset atrial fibrillation, there was no evidence that a rhythm control treatment strategy resulted in better outcomes than a rate control strategy. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42019128559 , identifier CRD42019128559.
No takes yet. Share an insight, caveat, or question.
Dairi et al. (2026) conducted a meta-analysis in Postoperative atrial fibrillation after cardiac surgery (n=894). Rhythm control strategy vs. Rate control strategy was evaluated on Hospital length of stay (MD -0.41, 95% CI -3.23, 2.42, p=0.78). A rhythm control strategy did not significantly reduce hospital length of stay compared to a rate control strategy in patients with postoperative atrial fibrillation after cardiac surgery (MD -0.41 days).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: