Rhythm vs Rate Control Strategies for Perioperative Atrial Fibrillation After Noncardiac Surgery: A Systematic Review and Meta-analysis.

BACKGROUND

For patients with perioperative atrial fibrillation (POAF) after noncardiac surgery, earlier conversion to sinus rhythm might improve outcomes. The efficacy of a rhythm vs rate control strategy for the acute management of POAF remains uncertain.

METHODS

We searched databases for randomized controlled trials (RCTs) and observational studies that included patients with POAF after noncardiac surgery and reported outcomes for patients acutely treated with a rhythm control strategy vs either a rate control or no treatment strategy. Studies were pooled using random effects models.

RESULTS

Of the observational studies, a rhythm control strategy was associated with higher conversion rates to sinus rhythm compared with a rate control or no treatment strategy (risk ratio [RR], 1.93; 95% confidence interval [CI], 1.25-2.97; 9 studies; N = 591). Compared with a rate control or no treatment strategy, a rhythm control strategy was not associated with differences in length of hospital stay (mean difference, -1.67 days; 95% CI, -7.10 to 3.76; 2 studies), length of intensive care stay (mean difference, -1.90 days; 95% CI, -7.62 to 3.82; 1 study), or all-cause mortality (RR, 1.12; 95% CI, 0.62-2.00; 5 studies). In an RCT that compared amiodarone vs magnesium, the RR was 0.56 for conversion to sinus rhythm (95% CI, 0.31-1.03; N = 34).

CONCLUSIONS

A rhythm control strategy was associated with greater success rates for conversion to sinus rhythm compared with a rate control or no treatment strategy. However, the observational studies were of low quality and only 1 small RCT was identified, and few data were available for other outcomes.