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Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery.

Publication ,  Journal Article
Gillinov, AM; Bagiella, E; Moskowitz, AJ; Raiten, JM; Groh, MA; Bowdish, ME; Ailawadi, G; Kirkwood, KA; Perrault, LP; Parides, MK; Smith, RL ...
Published in: N Engl J Med
May 19, 2016

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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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

May 19, 2016

Volume

374

Issue

20

Start / End Page

1911 / 1921

Location

United States

Related Subject Headings

  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • General & Internal Medicine
  • Female
  • Electric Countershock
  • Combined Modality Therapy
  • Cardiac Surgical Procedures
 

Citation

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Gillinov, A. M., Bagiella, E., Moskowitz, A. J., Raiten, J. M., Groh, M. A., Bowdish, M. E., … CTSN, . (2016). Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery. N Engl J Med, 374(20), 1911–1921. https://doi.org/10.1056/NEJMoa1602002
Gillinov, A Marc, Emilia Bagiella, Alan J. Moskowitz, Jesse M. Raiten, Mark A. Groh, Michael E. Bowdish, Gorav Ailawadi, et al. “Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery.N Engl J Med 374, no. 20 (May 19, 2016): 1911–21. https://doi.org/10.1056/NEJMoa1602002.
Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, et al. Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery. N Engl J Med. 2016 May 19;374(20):1911–21.
Gillinov, A. Marc, et al. “Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery.N Engl J Med, vol. 374, no. 20, May 2016, pp. 1911–21. Pubmed, doi:10.1056/NEJMoa1602002.
Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, Ailawadi G, Kirkwood KA, Perrault LP, Parides MK, Smith RL, Kern JA, Dussault G, Hackmann AE, Jeffries NO, Miller MA, Taddei-Peters WC, Rose EA, Weisel RD, Williams DL, Mangusan RF, Argenziano M, Moquete EG, O’Sullivan KL, Pellerin M, Shah KJ, Gammie JS, Mayer ML, Voisine P, Gelijns AC, O’Gara PT, Mack MJ, CTSN. Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery. N Engl J Med. 2016 May 19;374(20):1911–1921.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

May 19, 2016

Volume

374

Issue

20

Start / End Page

1911 / 1921

Location

United States

Related Subject Headings

  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • General & Internal Medicine
  • Female
  • Electric Countershock
  • Combined Modality Therapy
  • Cardiac Surgical Procedures