Frontiers in cardiovascular medicine · 2026
Rhythm vs. rate control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Dairi Mohammad S, Tarabzoni Mohammed, Tarola Christopher, Sehmbi Herman, Alwafi Hassan, Alghamdi Saeed M, Khan Sariya, Alotaibi Waleed Talal, Hegazy Ahmed F
Аннотация
BACKGROUND: We aimed to compare the clinical impact of treatment with a rhythm control strategy to a rate control strategy in postcardiac surgery atrial fibrillation patients.
METHODS: A comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and ClinicalTrials.gov was conducted from inception to October 2025. Our meta-analysis included randomized controlled trials (RCTs) comparing therapeutic rhythm control interventions with rate control interventions. We used the Cochrane risk-of-bias tool to appraise the quality of included RCTs, the GRADE framework to evaluate the strength of the evidence, and adhered to the PRISMA guidelines for reporting.
RESULTS: Eight RCTs (n = 894 patients) met the inclusion criteria. There was no difference in hospital length of stay (4 RCTs) between rhythm control and rate control [MD: -0.41 days (95% CI: -3.23, 2.42)]. An aggressive rhythm control strategy (ibutilide, procainamide, propafenone, or electric cardioversion) was associated with higher odds of in-hospital conversion to sinus rhythm [OR: 4.01 (95% CI: 1.30, 12.39)] and a higher risk of medication-related adverse events (hypotension, bradycardia, and syncope) [RR: 3.05 (95% CI: 1.05, 8.89)].
CONCLUSION: Among postcardiac surgery patients with new-onset atrial fibrillation, there was no evidence that a rhythm control treatment strategy resulted in better outcomes than a rate control strategy.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42019128559, identifier CRD42019128559.
METHODS: A comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and ClinicalTrials.gov was conducted from inception to October 2025. Our meta-analysis included randomized controlled trials (RCTs) comparing therapeutic rhythm control interventions with rate control interventions. We used the Cochrane risk-of-bias tool to appraise the quality of included RCTs, the GRADE framework to evaluate the strength of the evidence, and adhered to the PRISMA guidelines for reporting.
RESULTS: Eight RCTs (n = 894 patients) met the inclusion criteria. There was no difference in hospital length of stay (4 RCTs) between rhythm control and rate control [MD: -0.41 days (95% CI: -3.23, 2.42)]. An aggressive rhythm control strategy (ibutilide, procainamide, propafenone, or electric cardioversion) was associated with higher odds of in-hospital conversion to sinus rhythm [OR: 4.01 (95% CI: 1.30, 12.39)] and a higher risk of medication-related adverse events (hypotension, bradycardia, and syncope) [RR: 3.05 (95% CI: 1.05, 8.89)].
CONCLUSION: Among postcardiac surgery patients with new-onset atrial fibrillation, there was no evidence that a rhythm control treatment strategy resulted in better outcomes than a rate control strategy.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42019128559, identifier CRD42019128559.