Among the patients who have been discharged from the hospital with atrial fibrillation, direct-current cardioversion was performed during the index hospitalization in 3 of 26 patients (12%) in the rate-control group and in 7 of 17 patients (41%) in the rhythm-control group. DEATH AND ADVERSE EVENTS At 60 days, five individuals had died: three in the rate-control group and two in the rhythm-control group (P = 0.64). ineffectiveness (in the rate-control group) or amiodarone side effects or adverse drug reactions (in the rhythm-control group). At 60 days, 93.8% of the individuals in the rate-control group and 97.9% of those in the rhythm-control group experienced had a stable heart rhythm without atrial fibrillation for the previous 30 days (P = 0.02), and 84.2% and 86.9%, respectively, had been free from atrial fibrillation from discharge to 60 days (P = 0.41). CONCLUSIONS AB-680 Strategies for rate control and AB-680 rhythm control to treat postoperative atrial fibrillation were associated with equivalent numbers of days of hospitalization, related complication rates, and similarly low rates of prolonged atrial fibrillation 60 days after onset. Neither treatment strategy showed a online clinical advantage on the additional. (Funded from the National Institutes of Health and the Canadian Institutes of Health Study; ClinicalTrials.gov quantity, “type”:”clinical-trial”,”attrs”:”text”:”NCT02132767″,”term_id”:”NCT02132767″NCT02132767.) In recent years, much research offers focused on the prevention of atrial fibrillation after cardiac surgery, but highly effective interventions are lacking. Therefore, postoperative atrial fibrillation remains the most common complication after cardiac surgery, with an incidence of 20 to 50%.1C4 This complication has major adverse effects for individuals and the health care and attention system, including increased rates of death, complications, and hospitalizations and inflated costs.1C9 Therefore, efforts to determine the most effective preventive strategies and management practices are important. You will find two general approaches to controlling postoperative atrial fibrillation: heart-rate control (hereafter rate control) and rhythm control with the use of antiarrhythmic medicines, direct-current cardioversion, or both. In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, in which investigators studied the use of rate control versus rhythm control in nonsurgical individuals with atrial fibrillation, the use of rhythm control was shown to present no survival advantage but was associated with more frequent hospitalizations and adverse drug effects.10 However, some studies involving individuals with postoperative atrial fibrillation after cardiac surgery have suggested that rhythm control may offer advantages over rate control, although the evidence is inconclusive.3,11C13 The lack of consensus regarding best practices for the management of atrial fibrillation after cardiac surgery has led to major variations in practice patterns.1,3,14C16 Treatment approaches aim to reduce the severity of associated symptoms, limit adverse hemodynamic effects, decrease the length of hospital stay, prevent read-missions, and improve survival. Advocates of a rhythm-control strategy contend that a more rapid conversion to sinus rhythm might reduce thromboembolic risk, minimize exposure to anticoagulation, and restore practical capacity more quickly than rate control. Proponents of rate control counter that this approach averts the potential adverse effects of antiarrhythmic medicines and complications associated with cardioversion. Determining the risks and benefits of rate control versus rhythm control for Mouse monoclonal to V5 Tag postoperative atrial fibrillation may provide information to improve clinical decision making and resource utilization for this highly common condition. The Cardiothoracic Medical Tests Network (CTSN), consequently, carried out a randomized trial to evaluate AB-680 the performance and security of rate control versus rhythm control for new-onset atrial fibrillation or atrial flutter after cardiac surgery. METHODS TRIAL DESIGN AND OVERSIGHT This trial was carried out at 23 sites in the United States and Canada; the institutional evaluate table at each site authorized the protocol. A coordinating center, self-employed adjudication committee, and data and security monitoring table oversaw the progress of the trial. The investigators vouch for the fidelity of this report to the trial protocol, AB-680 which is available with the full text of this article at NEJM.org. Individuals AND INTERVENTIONS The trial enrolled adult individuals in.