Eunice Yang1, David Spragg1, Steven Schulman1, Nisha A Gilotra1, Ahmet Kilic2, Rawn Salenger3, Glenn Whitman2, Thomas S Metkus4. 1. Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD. 2. Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD. 3. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 4. Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD. Electronic address: tmetkus1@jhmi.edu.
Abstract
BACKGROUND: Whether rhythm control for post-operative atrial fibrillation after cardiac surgery (POAF) is superior to rate control in patients with heart failure or systolic dysfunction (HF) is not known. METHODS: We performed a post-hoc analysis of a trial by the Cardiothoracic Surgical Trials Network, which randomized patients with POAF after cardiac surgery to rate control or rhythm control with amiodarone/cardioversion. We assessed subgroups of trial participants defined by heart failure/cardiomyopathy history or left ventricular ejection fraction (LVEF) < 50%. We conducted a stratified analysis in patients with and without HF to explore outcomes of rhythm versus rate control strategy. RESULTS: Of 523 subjects with POAF after cardiac surgery, 131 (25%) had HF. 49% of HF patients were randomized to rhythm control. In HF patients, rhythm control was associated with less atrial fibrillation within the first 7 days. There were no differences in rhythm at 30- and 60-day follow-up. In the HF group, there were significantly more subjects with AF < 48 hours in the rhythm control group compared to rate control group- 68.8% compared to 46.3%, P=0.009. By comparison, in the non-HF stratum, 54.4% of the rate control group had AF < 48 hours compared to 63.5% of the rhythm control group (P=0.067).), though there was no significant interaction of heart failure with cardiac rhythm at 7 days (Pinteraction 0.16). CONCLUSION: Rhythm control for HF patients with POAF after cardiac surgery increases early restoration of sinus rhythm. Rate and rhythm control are both reasonable for HF patients with AF after cardiac surgery.
BACKGROUND: Whether rhythm control for post-operative atrial fibrillation after cardiac surgery (POAF) is superior to rate control in patients with heart failure or systolic dysfunction (HF) is not known. METHODS: We performed a post-hoc analysis of a trial by the Cardiothoracic Surgical Trials Network, which randomized patients with POAF after cardiac surgery to rate control or rhythm control with amiodarone/cardioversion. We assessed subgroups of trial participants defined by heart failure/cardiomyopathy history or left ventricular ejection fraction (LVEF) < 50%. We conducted a stratified analysis in patients with and without HF to explore outcomes of rhythm versus rate control strategy. RESULTS: Of 523 subjects with POAF after cardiac surgery, 131 (25%) had HF. 49% of HF patients were randomized to rhythm control. In HF patients, rhythm control was associated with less atrial fibrillation within the first 7 days. There were no differences in rhythm at 30- and 60-day follow-up. In the HF group, there were significantly more subjects with AF < 48 hours in the rhythm control group compared to rate control group- 68.8% compared to 46.3%, P=0.009. By comparison, in the non-HF stratum, 54.4% of the rate control group had AF < 48 hours compared to 63.5% of the rhythm control group (P=0.067).), though there was no significant interaction of heart failure with cardiac rhythm at 7 days (Pinteraction 0.16). CONCLUSION: Rhythm control for HF patients with POAF after cardiac surgery increases early restoration of sinus rhythm. Rate and rhythm control are both reasonable for HF patients with AF after cardiac surgery.
Authors: E G Daoud; R Weiss; M Bahu; B P Knight; F Bogun; R Goyal; M Harvey; S A Strickberger; K C Man; F Morady Journal: Am J Cardiol Date: 1996-12-15 Impact factor: 2.778
Authors: Mario Gaudino; A Pieter Kappetein; Antonino Di Franco; Emilia Bagiella; Deepak L Bhatt; Andreas Boening; Mary E Charlson; Marcus Flather; Annetine C Gelijns; Frederick Grover; Stuart J Head; Peter Jüni; Andre Lamy; Marissa Miller; Alan Moskowitz; Wilko Reents; A Laurie Shroyer; David P Taggart; Derrick Y Tam; Marco A Zenati; Stephen E Fremes Journal: J Am Coll Cardiol Date: 2020-04-07 Impact factor: 24.094
Authors: Joseph P Mathew; Manuel L Fontes; Iulia C Tudor; James Ramsay; Peter Duke; C David Mazer; Paul G Barash; Ping H Hsu; Dennis T Mangano Journal: JAMA Date: 2004-04-14 Impact factor: 56.272
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
Authors: Carol A Giffen; Elizabeth L Wagner; John T Adams; Denise M Hitchcock; Lisbeth A Welniak; Sean P Brennan; Leslie E Carroll Journal: PLoS One Date: 2017-06-14 Impact factor: 3.240