Management of Atrial Fibrillation After Cardiac Surgery

Abstract

A best-evidence topic in cardiac surgery was written according to a structured protocol [ [1] Dunning J. Prendergast B. Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg. 2003; 2: 405-409 Crossref PubMed Scopus (615) Google Scholar ]. The question addressed was ‘For post–cardiac surgery atrial fibrillation/flutter, do clinical outcomes differ between a rate or rhythm control strategy?’ Altogether, 442 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers were tabulated. Hospital length of stay ranged from 5.0 to 13.2 days for rate control and from 5.2 to 10.3 days for rhythm control. Freedom from atrial fibrillation at follow-up was achieved in 84.2%-91% and 84.2%-96% in rate and rhythm control groups, respectively. Minimal serious adverse events were noted in all studies analysed and there was no difference between rate and rhythm control groups. We conclude that in the management of post–cardiac surgery atrial fibrillation/flutter, rate control, and rhythm control are equivalent in terms of hospital length of stay, freedom from arrhythmia at follow-up, and complication rates.