Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis
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 t...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/13/4534 |
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| author | Muneeb Ahmed Emilie P. Belley-Coté Yuan Qiu Peter Belesiotis Brendan Tao Alex Wolf Hargun Kaur Alex Ibrahim Jorge A. Wong Michael K. Wang Jeff S. Healey David Conen Philip James Devereaux Richard P. Whitlock William F. Mcintyre |
| author_facet | Muneeb Ahmed Emilie P. Belley-Coté Yuan Qiu Peter Belesiotis Brendan Tao Alex Wolf Hargun Kaur Alex Ibrahim Jorge A. Wong Michael K. Wang Jeff S. Healey David Conen Philip James Devereaux Richard P. Whitlock William F. Mcintyre |
| author_sort | Muneeb Ahmed |
| collection | DOAJ |
| 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<sup>2</sup> = 97%), AF recurrence within 1 week (130 events; risk ratio [RR] 1.1; 95%CI 0.6–1.9, I<sup>2</sup> = 54%), AF recurrence up to 1 month (37 events; RR 0.9; 95%CI 0.5–1.8, I<sup>2</sup> = 0%), AF recurrence up to 3 months (10 events; RR 1.0; 95%CI 0.3–3.4, I<sup>2</sup> = 0%) or mortality (25 events; RR 1.6; 95%CI 0.7–3.5, I<sup>2</sup> = 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. |
| first_indexed | 2024-03-11T01:37:36Z |
| format | Article |
| id | doaj.art-e539d72c7b194d348969f96503dc2db4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T01:37:36Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-e539d72c7b194d348969f96503dc2db42023-11-18T16:55:16ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011213453410.3390/jcm12134534Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-AnalysisMuneeb Ahmed0Emilie P. Belley-Coté1Yuan Qiu2Peter Belesiotis3Brendan Tao4Alex Wolf5Hargun Kaur6Alex Ibrahim7Jorge A. Wong8Michael K. Wang9Jeff S. Healey10David Conen11Philip James Devereaux12Richard P. Whitlock13William F. Mcintyre14Faculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaOttawa Heart Institute, University of Ottawa, Ottawa, ON K1Y 4W7, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaDepartment of Medicine, University of British Columbia, Vancouver, BC V6T 1Z1, CanadaDepartment of Medicine, Western University, Hamilton, ON N6A 5C1, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaDepartment of Medicine, Western University, Hamilton, ON N6A 5C1, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaFaculty of Health Sciences, McMaster University, Hamilton, ON L8L 2X2, CanadaBackground: 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<sup>2</sup> = 97%), AF recurrence within 1 week (130 events; risk ratio [RR] 1.1; 95%CI 0.6–1.9, I<sup>2</sup> = 54%), AF recurrence up to 1 month (37 events; RR 0.9; 95%CI 0.5–1.8, I<sup>2</sup> = 0%), AF recurrence up to 3 months (10 events; RR 1.0; 95%CI 0.3–3.4, I<sup>2</sup> = 0%) or mortality (25 events; RR 1.6; 95%CI 0.7–3.5, I<sup>2</sup> = 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.https://www.mdpi.com/2077-0383/12/13/4534rhythm controlrate controlatrial fibrillationcardiac surgerylength of stay |
| spellingShingle | Muneeb Ahmed Emilie P. Belley-Coté Yuan Qiu Peter Belesiotis Brendan Tao Alex Wolf Hargun Kaur Alex Ibrahim Jorge A. Wong Michael K. Wang Jeff S. Healey David Conen Philip James Devereaux Richard P. Whitlock William F. Mcintyre Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis Journal of Clinical Medicine rhythm control rate control atrial fibrillation cardiac surgery length of stay |
| title | Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis |
| title_full | Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis |
| title_fullStr | Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis |
| title_short | Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis |
| title_sort | rhythm vs rate control in patients with postoperative atrial fibrillation after cardiac surgery a systematic review and meta analysis |
| topic | rhythm control rate control atrial fibrillation cardiac surgery length of stay |
| url | https://www.mdpi.com/2077-0383/12/13/4534 |
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