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Rhythm control for post-operative atrial fibrillation. Still a promising future?


Gillinov et al., (N Eng J Med. 2016; 374:20,1911-21) investigated the outcome of two strategies for managing post-operative atrial fibrillation (POAF) rate versus rhythm control. The trial was multicenter trial conducted in 23 centers in the US and Canada. The intervention for patients in the rate-control group was medications with a goal of HR <100b/m, where the rhythm-control group was treated with amiodarone rate slowing agent, and electrical cardioversion was given if AF persisted for 24-48 hours after randomization. The trial end point was hospital length of stay (LOSHOSP) within 60 days after randomization. POAF occurred in 33% of patients. The LOSHOSP was similar in both groups (median, 5.1 for rate control days and 5.0 days for rhythm control group, respectively; P=0.76). 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 did not show statistical significant differences. The authors concluded that both treatment strategies did not offer a clinical advantage over the other. We discussed how these results changed the working guidelines for managing POAF as the methodological limitations that underline the need for further investigations

Credits: Amr Omar, Abulaziz AlKulaifi



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Introduction to AFib
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