Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

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.

doi:10.1056/nejmoa1602002

Cited by 398Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac, Anesthesia and Surgical Outcomes

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. +24 more·2016·New England Journal of Medicine

DOI 10.1056/nejmoa1602002PMC PMC4908812

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Abstract

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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A recent medium-sized trial randomizing patients with postoperative AF to either rhythm control therapy with amiodarone or to rate control did not find a difference in hospital admissions during a 60-day follow-up.
“A recent medium-sized trial randomizing patients with postoperative AF to either rhythm control therapy with amiodarone or to rate control did not find a difference in hospital admissions during a 60day follow-up, 962”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [962]

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Authors: Gillinov, A. M., Bagiella, E., Moskowitz, A. J., Raiten, J. M., Groh, M. A., Bowdish, M. E., Ailawadi, G., Kirkwood, K. A., Perrault, L. P., Parides, M. K., Smith, R. L., Kern, J. A., Dussault, G., Hackmann, A. E., Jeffries, N. O., Miller, M. A., Taddei-Peters, W. C., Rose, E. A., Weisel, R. D., Williams, D. L., Mangusan, R. F., Argenziano, M., Moquete, E. G., O’Sullivan, K. L., Pellerin, M., Shah, K. J., Gammie, J. S., Mayer, M. L., Voisine, P., Gelijns, A. C., O’Gara, P. T., & Mack, M. J.
Affiliations: Cleveland Clinic (US)
Mission Health (US)
University of Southern California (US)
Icahn School of Medicine at Mount Sinai (US)
University of Maryland Medical Center (US)
Brigham and Women's Hospital (US)
ORCID: Gillinov, A. Marc
Bagiella, Emilia
Moskowitz, Alan J.
Bowdish, Michael E.
Ailawadi, Gorav
Kirkwood, Katherine A.
Perrault, Louis P.
Parides, Michael K.
Smith, Robert L.
Kern, John A.
Miller, Marissa A.
Williams, Deborah L.
Mangusan, Ralph F.
Argenziano, Michael
Gammie, James S.
Voisine, Pierre
Gelijns, Annetine C.
O’Gara, Patrick T.
Mack, Michael J.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2016-05-19
Volume: 374
Issue: 20
Pages: 1911-1921
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1602002
PMC: PMC4908812
OpenAlex: W2328315835
Cited by: 398
References: 22
Citations by year: 2026: 25 · 2025: 35 · 2024: 32 · 2023: 44 · 2022: 42 · 2021: 39 · 2020: 43 · 2019: 39 · 2018: 34 · 2017: 45 · 2016: 20
FWCI: 37.88
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: Brigham and Women's Hospital
University of Southern California
University of Pennsylvania
University of Toronto
Université de Montréal
Institut de Cardiologie de Montréal
National Institutes of Health (5u01hl088953-05)
Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval
Canadian Institutes of Health Research
National Heart, Lung, and Blood Institute (UM1HL117922, UM1HL118007, R01HL102121, UM1HL088963, UM1HL088953, UM1HL088939, UM1HL088955, UM1HL117924, U01HL088942, UM1HL088925, U01-HL088953)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: postoperative atrial fibrillation, cardiac surgery, rate control, rhythm control, amiodarone, hospitalization, persistent atrial fibrillation, anticoagulation, thromboembolism, bleeding events, adverse drug reactions
MeSH terms: Adrenergic beta-Antagonists, Aged, Amiodarone, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Atrial Fibrillation, Combined Modality Therapy, Electric Countershock, Female, Heart Rate, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Postoperative Complications

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Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

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