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

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-05-01 DOI:10.1016/j.cjco.2025.01.018

Michael Ke Wang MD , Ghazal Razeghi BSc , Geethan Baskaran BHSc , Louis Park BHSc , Steffen Blum MD, PhD , Rachel Heo MD , Tina Stegmann MD , P.J. Devereaux MD, PhD , William F. McIntyre MD, PhD , Jeff S. Healey MD, MSc , Michael Prystajecky MD, MSc , Rémi LeBlanc MD , Shannon M. Ruzycki MD , Mohamed Panju MD , Kiven Vuong BSc, MPH , David Conen MD, MPH

{"title":"Rhythm vs Rate Control Strategies for Perioperative Atrial Fibrillation After Noncardiac Surgery: A Systematic Review and Meta-analysis","authors":"Michael Ke Wang MD , Ghazal Razeghi BSc , Geethan Baskaran BHSc , Louis Park BHSc , Steffen Blum MD, PhD , Rachel Heo MD , Tina Stegmann MD , P.J. Devereaux MD, PhD , William F. McIntyre MD, PhD , Jeff S. Healey MD, MSc , Michael Prystajecky MD, MSc , Rémi LeBlanc MD , Shannon M. Ruzycki MD , Mohamed Panju MD , Kiven Vuong BSc, MPH , David Conen MD, MPH","doi":"10.1016/j.cjco.2025.01.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 5","pages":"Pages 579-587"},"PeriodicalIF":2.5000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X25000472","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

非心脏手术后围手术期心房颤动的心律与心率控制策略：系统回顾和荟萃分析

对于非心脏手术后围手术期心房颤动（POAF）患者，早期转换为窦性心律可能会改善预后。心律与心率控制策略在急性POAF治疗中的效果仍不确定。方法：我们检索了随机对照试验（rct）和观察性研究的数据库，这些研究包括非心脏手术后POAF患者，并报告了心律控制策略与心率控制策略或不治疗策略急性治疗患者的结果。研究采用随机效应模型进行汇总。结果在观察性研究中，与心律控制或不治疗策略相比，心律控制策略与更高的窦性心律转换率相关(风险比[RR]， 1.93；95%置信区间[CI]， 1.25-2.97；9的研究;N = 591)。与速率控制或无治疗策略相比，节律控制策略与住院时间的差异无关(平均差异为-1.67天；95% CI, -7.10 ~ 3.76；2项研究)、重症监护时间(平均差异为-1.90天；95% CI, -7.62 ~ 3.82；1项研究)或全因死亡率(RR, 1.12；95% ci, 0.62-2.00；5研究)。在一项比较胺碘酮与镁的随机对照试验中，转化为窦性心律的RR为0.56 (95% CI, 0.31-1.03；N = 34)。结论心律控制策略与心律控制或不治疗策略相比，具有更高的窦性心律转归成功率。然而，观察性研究质量较低，仅确定了1项小型RCT，其他结果的数据很少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊