Early Antiarrhythmic Therapy Is No Better than Rate Control Therapy Alone for Suppression of Atrial Fibrillation After Cardiac Surgery

Abstract

Background: Despite recent advances in therapy for atrial fibrillation (AF) following cardiac surgery, the potential superiority of antiarrhythmics over rate control therapy for suppression of AF has not been convincingly demonstrated. We sought to determine whether early treatment of AF following cardiac surgery with antiarrhythmics improves clinical outcome, as measured by recurrence rate, length of stay, and adverse events. Methods: Out of 1100 consecutive patients undergoing cardiovascular surgery from July 1997 to June 1998, AF was identified in 425 (38.6%) prior to discharge. Patients with a history of chronic AF prior to cardiovascular surgery and patients who died within 48 hours of cardiovascular surgery were excluded from the analysis; 365 patients were studied. Group I patients received rate control alone; Group II received antiarrhythmic drugs within 24 hours of the first onset of AF. Results: With the exception of frequency of pulmonary disease (4 vs 17, P = 0.009), CABG rate (35 vs 45%, P = 0.045), and rate of valve surgery (24 vs 15%, P = 0.028), there were no significant differences in clinical characteristics between the two groups. The rate of return to sinus rhythm within 24 hours (80 vs 82%), and the percentage of patients leaving the hospital in sinus rhythm (90 vs 92%) were similar between the two groups, as were total length of stay (10.6 ± 6.0 vs. 11.4 ± 5.8, P = 0.159) and postoperative length of stay (8.4 ± 15.0 vs. 9.4 ± 5.3, P = 0.061). Embolic event rates were similar in both groups (eight in Group I and three in Group II). Proarrhythmia occurred in two patients receiving early antiarrhythmic therapy. Conclusion: Traditional use of early antiarrhythmic therapy appears to provide no clear advantage to rate control after cardiovascular surgery in terms of length of stay, freedom from AF at discharge, and other common clinical outcomes. Routine use of antiarrhythmics for suppression of AF should be carefully reconsidered. A.N.E. 2000;5(4):365–372