Morbidity of Post-Coronary Artery Bypass Surgery Patients with Atrial Fibrillation Treated with Rate Control versus Sinus-Restoring Therapy

Abstract

Background: Atrial fibrillation (AF) is the most common dysrhythmia encountered in the post-coronary artery bypass (post-CABG) patient, reported to occur with a frequency of 20–40%. To date, with the exception of amiodarone, there is no evidence that prophylactic therapy or therapy to restore and maintain sinus rhythm reduces the risk of adverse events associated with AF. Objective: To determine whether rate control alone is an effective method of managing post-CABG AF. Method: Prospective nonrandomized observational pilot study to assess the outcome of patients with post-CABG AF managed with rate control (group 1) or a combination of rate control and sinus-restoring therapy (group 2). Adverse events, postoperative length of stay, and persistence of AF were assessed in both groups at discharge and 30 days post-discharge. Results: Post-CABG AF was observed in 101 patients. Among the 39 patients in group 1 and 62 patients in group 2, there was an 87% spontaneous conversion rate to sinus rhythm at discharge (p = 0.99). The surgical length of stay was 6.3 days in group 1, and 8.3 days in group 2 (p = 0.01). Adverse events were observed in 2 patients (5.1%) in group 1, and 7 patients (11.3%) in group 2 (p = 0.29). Conclusion: Rate control appears to be an effective method of management of post-CABG AF patients, reducing length of hospital stay without increasing the rate of adverse events. Similar proportions of patients from both groups were in sinus rhythm at time of discharge, irrespective of therapeutic techniques.