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Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis.
- Source :
-
Journal of Clinical Medicine . Jul2023, Vol. 12 Issue 13, p4534. 11p. - Publication Year :
- 2023
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ATRIAL fibrillation
*CARDIAC surgery
*RHYTHM
*CARDIAC patients
Subjects
Details
- Language :
- English
- ISSN :
- 20770383
- Volume :
- 12
- Issue :
- 13
- Database :
- Academic Search Index
- Journal :
- Journal of Clinical Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 164925251
- Full Text :
- https://doi.org/10.3390/jcm12134534