Document Detail


Rate-control versus conversion strategy in postoperative atrial fibrillation: trial design and pilot study results.
MedLine Citation:
PMID:  14618047     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Atrial fibrillation (AF) remains a frequent complication of cardiac surgery. The optimal treatment strategy has not been established. Retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. Fifty patients with postoperative atrial fibrillation were randomly assigned to a strategy of antiarrhythmic therapy +/- electrical cardioversion or ventricular rate control. Anticoagulation with heparin overlapped with coumadin was administered to both arms. The primary endpoint of the study was time to conversion to sinus rhythm analyzed by the Kaplan-Meier method. The effects of strategy on hospital length of stay was examined as well as the incidence of recurrent AF. This study demonstrated no significant difference between an antiarrhythmic conversion strategy (n = 27) and a rate-control strategy (n = 23) in time to conversion to sinus rhythm (11.2 +/- 3.2 vs. 11.8 +/- 3.9 hours; p = 0.8). With Cox multivariate analysis to control for the effects of age, sex, beta-blocker usage, and type of surgery, the conversion strategy showed a trend toward reducing the time from treatment to restoration of sinus rhythm (p = 0.08). The length of hospital stay was reduced in the antiarrhythmic arm compared with the rate-control strategy (9.0 +/- 0.7 vs. 13.2 +/- 2.0 days; p = 0.05). In hospital relapse rates in the antiarrhythmic arm were 30% compared with 57% in the rate-control strategy (p = 0.24). At the termination of the study, 91% of the patients in the rate-control arm were in sinus rhythm compared with 96% in the antiarrhythmic arm. In conclusion, this pilot study shows little difference between a rate-control strategy and a strategy to restore/maintain sinus rhythm. Regardless of the strategy, majority of patients will be in sinus rhythm after two months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
Authors:
John K Lee; George J Klein; Andrew D Krahn; Raymond Yee; Kelly Zarnke; Christopher Simpson; Allan Skanes
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Cardiac electrophysiology review     Volume:  7     ISSN:  1385-2264     ISO Abbreviation:  Card Electrophysiol Rev     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-11-17     Completed Date:  2004-05-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9708907     Medline TA:  Card Electrophysiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  178-84     Citation Subset:  IM    
Affiliation:
The Arrhythmia Service, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada. jklee@kccardiology.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / adverse effects,  therapeutic use
Aged
Amiodarone / therapeutic use
Anti-Arrhythmia Agents / adverse effects,  therapeutic use*
Arrhythmia, Sinus / physiopathology,  therapy
Atrial Fibrillation / physiopathology,  therapy*
Atrioventricular Node / drug effects,  physiopathology,  surgery
Calcium Channel Blockers / therapeutic use
Cardiac Surgical Procedures*
Electric Countershock*
Female
Heart Rate / drug effects*
Heart Ventricles / drug effects,  physiopathology,  surgery
Humans
Length of Stay
London
Male
Middle Aged
Pilot Projects
Postoperative Complications / mortality,  physiopathology*,  therapy*
Procainamide / therapeutic use
Propafenone / therapeutic use
Prospective Studies
Recurrence
Sotalol / therapeutic use
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; 1951-25-3/Amiodarone; 3930-20-9/Sotalol; 51-06-9/Procainamide; 54063-53-5/Propafenone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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