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Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine, ISSN: 2077-0383, Vol: 12, Issue: 13
2023
  • 4
    Citations
  • 0
    Usage
  • 20
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  • 2
    Mentions
  • 0
    Social Media
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Studies in the Area of Atrial Fibrillation Reported from McMaster University (Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis)

2023 JUL 21 (NewsRx) -- By a News Reporter-Staff News Editor at NewsRx Cardiovascular Daily -- New research on atrial fibrillation is the subject of

Review Description

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, I = 97%), AF recurrence within 1 week (130 events; risk ratio [RR] 1.1; 95%CI 0.6–1.9, I = 54%), AF recurrence up to 1 month (37 events; RR 0.9; 95%CI 0.5–1.8, I = 0%), AF recurrence up to 3 months (10 events; RR 1.0; 95%CI 0.3–3.4, I = 0%) or mortality (25 events; RR 1.6; 95%CI 0.7–3.5, I = 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.

Bibliographic Details

Ahmed, Muneeb; Belley-Coté, Emilie P; Qiu, Yuan; Belesiotis, Peter; Tao, Brendan; Wolf, Alex; Kaur, Hargun; Ibrahim, Alex; Wong, Jorge A; Wang, Michael K; Healey, Jeff S; Conen, David; Devereaux, Philip James; Whitlock, Richard P; Mcintyre, William F

MDPI AG

Medicine

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