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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

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Rate-control versus conversion strategy in postoperative atrial fibrillation: a prospective, randomized pilot study.

J K Lee¹, G J Klein, A D Krahn

¹Arrhythmia Monitoring Unit, University of Western Ontario, London Health Sciences Centre, Canada. jklep@hotmail.com

American Heart Journal

|December 2, 2000

Summary

This study found no significant difference in time to sinus rhythm between antiarrhythmic therapy and rate-control strategies for post-heart surgery atrial fibrillation. Both approaches effectively restored normal heart rhythm, with a trend towards shorter hospital stays with antiarrhythmic treatment.

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Area of Science:

Cardiology
Cardiac Surgery
Electrophysiology

Background:

Atrial fibrillation (AF) is a common complication following cardiac surgery.
The optimal treatment strategy for post-operative AF remains unclear.
Previous studies suggest rate control may be as effective as rhythm restoration.

Purpose of the Study:

To compare the efficacy of antiarrhythmic therapy versus ventricular rate control for treating atrial fibrillation after heart surgery.
To evaluate the time to conversion to sinus rhythm and relapse rates.
To assess the impact on hospital length of stay.

Main Methods:

A randomized pilot study involving 50 patients with post-cardiac surgery AF.
Patients were assigned to either an antiarrhythmic conversion strategy (with or without electrical cardioversion) or a rate-control strategy.
Both groups received anticoagulation; primary endpoint was time to sinus rhythm conversion.

Main Results:

No significant difference in time to sinus rhythm conversion between the two strategies (11.2 vs 11.8 hours).
The antiarrhythmic strategy showed a trend towards faster sinus rhythm restoration (P=.08) and significantly reduced hospital stay (P=.05).
In-hospital relapse rates were 30% for antiarrhythmics vs 57% for rate control (P=.24); long-term relapse rates were similar.

Conclusions:

This pilot study indicates minimal differences between rate-control and rhythm-restoration strategies for post-operative AF.
Most patients achieve sinus rhythm within two months, irrespective of the strategy used.
Larger randomized trials are needed to confirm the impact of rhythm restoration on length of stay.