Objective:

To compare the clinical impact of rhythm control versus rate control strategies in postcardiac surgery patients with new-onset atrial fibrillation.

Approach:

• Search Strategy: A comprehensive search of multiple databases was conducted to identify randomized controlled trials comparing rhythm control and rate control interventions.
• Study Selection: Included studies were randomized controlled trials involving adult patients with postoperative atrial fibrillation after cardiac surgery.
• Outcomes: Primary outcome was hospital length of stay; secondary outcomes included in-hospital conversion rates to normal sinus rhythm and medication-related adverse events.

Key Findings:

• No difference in hospital length of stay between rhythm control and rate control strategies (MD: −0.41 days, 95% CI: −3.23, 2.42).
• Aggressive rhythm control strategies increased the odds of in-hospital conversion to sinus rhythm (OR: 4.01, 95% CI: 1.30, 12.39).
• Rhythm control strategies were associated with a higher risk of medication-related adverse events (RR: 3.05, 95% CI: 1.05, 8.89).

Interpretation:

Rhythm control did not demonstrate better outcomes compared to rate control among postcardiac surgery patients with new-onset atrial fibrillation.

Limitations:

• Limited number of studies included in the meta-analysis.
• Variability in interventions and follow-up durations across studies.

Conclusion:

There was no evidence that rhythm control strategies resulted in superior outcomes compared to rate control in postcardiac surgery patients with new-onset atrial fibrillation.

Sources:

• Systematic Review Registration