Rate control versus rhythm control for atrial fibrillation after cardiac surgery

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

Research output: Contribution to journalArticle

106 Citations (Scopus)

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 ranksum 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.

Original languageEnglish (US)
Pages (from-to)1911-1921
Number of pages11
JournalNew England Journal of Medicine
Volume374
Issue number20
DOIs
StatePublished - May 19 2016
Externally publishedYes

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Atrial Fibrillation
Thoracic Surgery
Control Groups
Hospitalization
Random Allocation
Amiodarone
Mortality
Drug-Related Side Effects and Adverse Reactions
Therapeutics
Heart Rate
Hemorrhage
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gillinov, A. M., Bagiella, E., Moskowitz, A. J., Raiten, J. M., Groh, M. A., Bowdish, M. E., ... Mack, M. J. (2016). Rate control versus rhythm control for atrial fibrillation after cardiac surgery. New England Journal of Medicine, 374(20), 1911-1921. https://doi.org/10.1056/NEJMoa1602002

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.

In: New England Journal of Medicine, Vol. 374, No. 20, 19.05.2016, p. 1911-1921.

Research output: Contribution to journalArticle

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 2016, 'Rate control versus rhythm control for atrial fibrillation after cardiac surgery', New England Journal of Medicine, vol. 374, no. 20, pp. 1911-1921. 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. New England Journal of Medicine. 2016 May 19;374(20):1911-1921. https://doi.org/10.1056/NEJMoa1602002
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. / Rate control versus rhythm control for atrial fibrillation after cardiac surgery. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 20. pp. 1911-1921.
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author = "Gillinov, {A. Marc} and Emilia Bagiella and Moskowitz, {Alan J.} and Raiten, {Jesse M.} and Groh, {Mark A.} and Bowdish, {Michael E.} and Gorav Ailawadi and Kirkwood, {Katherine A.} and Perrault, {Louis P.} and Parides, {Michael K.} and Smith, {Robert L.} and Kern, {John A.} and Gladys Dussault and Hackmann, {Amy E.} and Jeffries, {Neal O.} and Miller, {Marissa A.} and Taddei-Peters, {Wendy C.} and Rose, {Eric A.} and Weisel, {Richard D.} and Williams, {Deborah L.} and Mangusan, {Ralph F.} and Michael Argenziano and Moquete, {Ellen G.} and O'Sullivan, {Karen L.} and Michel Pellerin and Shah, {Kinjal J.} and Gammie, {James S.} and Mayer, {Mary Lou} and Pierre Voisine and Gelijns, {Annetine C.} and O'Gara, {Patrick T.} and Mack, {Michael J.}",
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T1 - Rate control versus rhythm control for atrial fibrillation after cardiac surgery

AU - Gillinov, A. Marc

AU - Bagiella, Emilia

AU - Moskowitz, Alan J.

AU - Raiten, Jesse M.

AU - Groh, Mark A.

AU - Bowdish, Michael E.

AU - Ailawadi, Gorav

AU - Kirkwood, Katherine A.

AU - Perrault, Louis P.

AU - Parides, Michael K.

AU - Smith, Robert L.

AU - Kern, John A.

AU - Dussault, Gladys

AU - Hackmann, Amy E.

AU - Jeffries, Neal O.

AU - Miller, Marissa A.

AU - Taddei-Peters, Wendy C.

AU - Rose, Eric A.

AU - Weisel, Richard D.

AU - Williams, Deborah L.

AU - Mangusan, Ralph F.

AU - Argenziano, Michael

AU - Moquete, Ellen G.

AU - O'Sullivan, Karen L.

AU - Pellerin, Michel

AU - Shah, Kinjal J.

AU - Gammie, James S.

AU - Mayer, Mary Lou

AU - Voisine, Pierre

AU - Gelijns, Annetine C.

AU - O'Gara, Patrick T.

AU - Mack, Michael J.

PY - 2016/5/19

Y1 - 2016/5/19

N2 - 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 ranksum 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.

AB - 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 ranksum 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.

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