BACKGROUND: Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. METHODS:Fifty patients with atrial fibrillation after heart surgery were randomly assigned to a strategy of antiarrhythmic therapy with or without electrical cardioversion or ventricular rate control. Both arms received anticoagulation with heparin overlapped with warfarin. The primary end point was time to conversion to sinus rhythm analyzed by the Kaplan-Meier method. Atrial fibrillation relapse after the initial conversion was monitored in the hospital over a 2-month period. RESULTS: There was no significant difference between an antiarrhythmic conversion strategy (n = 27) and a rate-control strategy (n = 23) in time to conversion to sinus rhythm (11.2 +/- 3. 2 vs 11.8 +/- 3.9 hours; P =.8). With the use of Cox multivariate analysis to control for the effects of age, sex, beta-blocker usage, and type of surgery, the antiarrhythmic strategy showed a trend toward reducing the time from treatment to restoration of sinus rhythm (P =.08). The length of hospital stay was reduced in the antiarrhythmic arm compared with the rate-control strategy (9.0 +/- 0.7 vs 13.2 +/- 2.0 days; P =.05). In-hospital relapse rates in the antiarrhythmic arm were 30% compared with 57% in the rate-control strategy (P =.24). There were no significant difference in relapse rates at 1 week (24% vs 28%), 4 weeks (6% vs 12%), and 6 to 8 weeks (4% vs 9%). At the end of the study, 91% of the patients in the rate-control arm were in sinus rhythm compared with 96% in the antiarrhythmic arm (P =.6). CONCLUSIONS: This pilot study shows little difference between a rate-control strategy and a strategy to restore sinus rhythm. Regardless of strategy, most patients will be in sinus rhythm after 2 months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
RCT Entities:
BACKGROUND:Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. METHODS: Fifty patients with atrial fibrillation after heart surgery were randomly assigned to a strategy of antiarrhythmic therapy with or without electrical cardioversion or ventricular rate control. Both arms received anticoagulation with heparin overlapped with warfarin. The primary end point was time to conversion to sinus rhythm analyzed by the Kaplan-Meier method. Atrial fibrillation relapse after the initial conversion was monitored in the hospital over a 2-month period. RESULTS: There was no significant difference between an antiarrhythmic conversion strategy (n = 27) and a rate-control strategy (n = 23) in time to conversion to sinus rhythm (11.2 +/- 3. 2 vs 11.8 +/- 3.9 hours; P =.8). With the use of Cox multivariate analysis to control for the effects of age, sex, beta-blocker usage, and type of surgery, the antiarrhythmic strategy showed a trend toward reducing the time from treatment to restoration of sinus rhythm (P =.08). The length of hospital stay was reduced in the antiarrhythmic arm compared with the rate-control strategy (9.0 +/- 0.7 vs 13.2 +/- 2.0 days; P =.05). In-hospital relapse rates in the antiarrhythmic arm were 30% compared with 57% in the rate-control strategy (P =.24). There were no significant difference in relapse rates at 1 week (24% vs 28%), 4 weeks (6% vs 12%), and 6 to 8 weeks (4% vs 9%). At the end of the study, 91% of the patients in the rate-control arm were in sinus rhythm compared with 96% in the antiarrhythmic arm (P =.6). CONCLUSIONS: This pilot study shows little difference between a rate-control strategy and a strategy to restore sinus rhythm. Regardless of strategy, most patients will be in sinus rhythm after 2 months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
Authors: Jacqueline E Tamis-Holland; Marcin Kowalski; Velisar Rill; Kamran Firoozi; Jonathan S Steinberg Journal: Ann Noninvasive Electrocardiol Date: 2006-04 Impact factor: 1.468
Authors: Heidi Oi-Yee Li; Heather A Smith; Olivier Brandts-Longtin; Donna E Maziak; Sebastien Gilbert; Paul Villeneuve; Sudhir Sundaresan; Andrew J E Seely Journal: Gen Thorac Cardiovasc Surg Date: 2021-01-05
Authors: Gyorgy Frendl; Alissa C Sodickson; Mina K Chung; Albert L Waldo; Bernard J Gersh; James E Tisdale; Hugh Calkins; Sary Aranki; Tsuyoshi Kaneko; Stephen Cassivi; Sidney C Smith; Dawood Darbar; Jon O Wee; Thomas K Waddell; David Amar; Dale Adler Journal: J Thorac Cardiovasc Surg Date: 2014-06-30 Impact factor: 5.209
Authors: Shuab Omer; Lorraine D Cornwell; Ankur Bakshi; Eric Rachlin; Ourania Preventza; Todd K Rosengart; Joseph S Coselli; Scott A LeMaire; Nancy J Petersen; Greg Pattakos; Faisal G Bakaeen Journal: Tex Heart Inst J Date: 2016-10-01
Authors: A Marc Gillinov; Emilia Bagiella; Alan J Moskowitz; Jesse M Raiten; Mark A Groh; Michael E Bowdish; Gorav Ailawadi; Katherine A Kirkwood; Louis P Perrault; Michael K Parides; Robert L Smith; John A Kern; Gladys Dussault; Amy E Hackmann; Neal O Jeffries; Marissa A Miller; Wendy C Taddei-Peters; Eric A Rose; Richard D Weisel; Deborah L Williams; Ralph F Mangusan; Michael Argenziano; Ellen G Moquete; Karen L O'Sullivan; Michel Pellerin; Kinjal J Shah; James S Gammie; Mary Lou Mayer; Pierre Voisine; Annetine C Gelijns; Patrick T O'Gara; Michael J Mack Journal: N Engl J Med Date: 2016-04-04 Impact factor: 91.245