Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery.
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Gillinov A Marc, Bagiella Emilia, Moskowitz Alan J, Raiten Jesse M, Groh Mark A, Bowdish Michael E, Ailawadi Gorav, Kirkwood Katherine A, Perrault Louis P, Parides Michael K, Smith Robert L, Kern John A, Dussault Gladys, Hackmann Amy E, Jeffries Neal O, Miller Marissa A, Taddei-Peters Wendy C, Rose Eric A, Weisel Richard D, Williams Deborah L, Mangusan Ralph F, Argenziano Michael, Moquete Ellen G, O'Sullivan Karen L, Pellerin Michel, Shah Kinjal J, Gammie James S, Mayer Mary Lou, Voisine Pierre, Gelijns Annetine C, O'Gara Patrick T, Mack Michael J, CTSN
Аннотация
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.).