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CTS trials network: Rate control vs rhythm control for atrial fibrillation after cardiac surgery - Do bitter pills have blessed effects?

ABSTRACT: New onset AF is a very common sequel of cardiac surgery with an incidence reaching 50% in some studies. This post-operative complication leads to increased morbidity, hospital stay and, consequently, hospital costs1. Currently there is a great variability in the management of this condition. Despite efforts to produce best practice guidelines2, what best to do for a patient who develops AF post-operatively remains a question. In a systematic attempt to find an answer to this question, the Cardiothoracic Trials Network have recently published the results of their trial "Rate Control Versus Rhythm Control for Atrial Fibrillation After Cardiac Surgery"3 (clinicaltrials.gov number: NCT02132767).

SUBMITTER: Afifi A

PROVIDER: S-EPMC5642745 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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CTS trials network: Rate control vs rhythm control for atrial fibrillation after cardiac surgery - Do bitter pills have blessed effects?

Afifi Ahmed A

Global cardiology science & practice 20160630 2

New onset AF is a very common sequel of cardiac surgery with an incidence reaching 50% in some studies. This post-operative complication leads to increased morbidity, hospital stay and, consequently, hospital costs<sup>1</sup>. Currently there is a great variability in the management of this condition. Despite efforts to produce best practice guidelines<sup>2</sup>, what best to do for a patient who develops AF post-operatively remains a question. In a systematic attempt to find an answer to thi ...[more]

PMID: 29043263

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Project description:BACKGROUND:Atrial fibrillation after cardiac surgery is associated with increased rates of death, complications, and hospitalizations. In patients with postoperative atrial fibrillation who are in stable condition, the best initial treatment strategy--heart-rate control or rhythm control--remains controversial. METHODS:Patients with new-onset postoperative atrial fibrillation were randomly assigned to undergo either rate control or rhythm control. The primary end point was the total number of days of hospitalization within 60 days after randomization, as assessed by the Wilcoxon rank-sum test. RESULTS:Postoperative atrial fibrillation occurred in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of these patients, 523 underwent randomization. The total numbers of hospital days in the rate-control group and the rhythm-control group were similar (median, 5.1 days and 5.0 days, respectively; P=0.76). There were no significant between-group differences in the rates of death (P=0.64) or overall serious adverse events (24.8 per 100 patient-months in the rate-control group and 26.4 per 100 patient-months in the rhythm-control group, P=0.61), including thromboembolic and bleeding events. About 25% of the patients in each group deviated from the assigned therapy, mainly because of drug ineffectiveness (in the rate-control group) or amiodarone side effects or adverse drug reactions (in the rhythm-control group). At 60 days, 93.8% of the patients in the rate-control group and 97.9% of those in the rhythm-control group had had a stable heart rhythm without atrial fibrillation for the previous 30 days (P=0.02), and 84.2% and 86.9%, respectively, had been free from atrial fibrillation from discharge to 60 days (P=0.41). CONCLUSIONS:Strategies for rate control and rhythm control to treat postoperative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates, and similarly low rates of persistent atrial fibrillation 60 days after onset. Neither treatment strategy showed a net clinical advantage over the other. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02132767.).

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CTS trials network: Rate control vs rhythm control for atrial fibrillation after cardiac surgery - Do bitter pills have blessed effects?

Publications

CTS trials network: Rate control vs rhythm control for atrial fibrillation after cardiac surgery - Do bitter pills have blessed effects?

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