Key result
Rhythm control compared to rate control did not significantly reduce length of stay (MD -0.8 days; 95% CI -3.0 to 1.4) or AF recurrence within 1 week (RR 1.1; 95% CI 0.6-1.9) in patients with POAF.
Why the study?
Postoperative atrial fibrillation is the most common complication after cardiac surgery and is associated with morbidity and mortality, but the comparative effects of rhythm versus rate control required evaluation.
Does rhythm control improve outcomes compared to rate control in cardiac surgery patients with postoperative atrial fibrillation?
Systematic Review (n=2,418)
Does rhythm control improve outcomes compared to rate control in cardiac surgery patients with postoperative atrial fibrillation?
In patients with postoperative atrial fibrillation after cardiac surgery, there is no clear advantage to either rhythm or rate control based on currently available low-quality evidence.
Answers are grounded in this paper and cite their sources.
Rate or rhythm control may be used interchangeably for POAF; confirms no advantage of either strategy and highlights need for larger RCTs.
Background: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery; it is associated with morbidity and mortality. We undertook this review to compare the effects of rhythm vs. rate control in this population. Methods: We searched MEDLINE, Embase and CENTRAL to March 2023. We included randomized trials and observational studies comparing rhythm to rate control in cardiac surgery patients with POAF. We used a random-effects model to meta-analyze data and rated the quality of evidence using GRADE. Results: From 8,110 citations, we identified 8 randomized trials (990 patients). Drug regimens used for rhythm control included amiodarone in four trials, other class III anti-arrhythmics in one trial, class I anti-arrhythmics in four trials and either a class I or III anti-arrhythmic in one trial. Rhythm control compared to rate control did not result in a significant difference in length of stay (mean difference −0.8 days; 95% CI −3.0 to +1.4, I2 = 97%), AF recurrence within 1 week (130 events; risk ratio [RR] 1.1; 95%CI 0.6–1.9, I2 = 54%), AF recurrence up to 1 month (37 events; RR 0.9; 95%CI 0.5–1.8, I2 = 0%), AF recurrence up to 3 months (10 events; RR 1.0; 95%CI 0.3–3.4, I2 = 0%) or mortality (25 events; RR 1.6; 95%CI 0.7–3.5, I2 = 0%). Effect measures from seven observational studies (1428 patients) did not differ appreciably from those in randomized trials. Conclusions: Although atrial fibrillation is common after cardiac surgery, limited low-quality data guide its management. Limited available evidence suggests no clear advantage to either rhythm or rate control. A large-scale randomized trial is needed to inform this important clinical question.
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Ahmed et al. (2023) conducted a systematic review in Postoperative atrial fibrillation after cardiac surgery (n=2,418). Rhythm control vs. Rate control was evaluated on Length of stay (MD -0.8, 95% CI -3.0 to 1.4). Rhythm control compared to rate control did not significantly reduce length of stay (MD -0.8 days; 95% CI -3.0 to 1.4) or AF recurrence within 1 week (RR 1.1; 95% CI 0.6-1.9) in patients with POAF.
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