Rate Control Versus Rhythm Control For Postoperative Atrial Fibrillation

Icahn School of Medicine at Mount Sinai523 enrolled

Overview

The purpose of this study is to compare the therapeutic strategies of rate control versus rhythm control in cardiac surgery patients who develop in-hospital postoperative atrial fibrillation or atrial flutter (AF). In patients who develop AF during hospitalization after cardiac surgery, the hypothesis is that a strategy of rhythm control will reduce days in hospital within 60 days of the occurrence of AF compared to a strategy of rate control.

The purpose of the research is to compare two strategies for treating atrial fibrillation or atrial flutter, both of which are referred to as AF, after cardiac surgery. AF is the most common complication after cardiac surgery. AF is when the upper chambers of the heart (atria) experience disorganized electrical activity which causes the heart beat to be irregular. The two treatment strategies to be used in this study are called rhythm control and rate control. The rhythm control strategy will attempt to bring the heart beat back to a regular rhythm using treatments known and approved to control heart rhythm. The rate control strategy will attempt to bring the heart rate to less than 100 beats per minute at rest using medications known and recommended to control heart rate. Both strategies are commonly used to treat AF. All of the medications that will be used in this study are the standard of care for use in patients experiencing AF. This research seeks to determine whether rhythm control is better than rate control in patients with AF after cardiac surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

523

Conditions

Postoperative Atrial Fibrillation

Interventions

AmiodaroneDRUG

Amiodarone Initial Dose * Oral: 400 mg po TID for 3 days is recommended * For patients incapable of taking oral: 150 mg IV bolus over 10 min, then 1 mg/min over 6 hours followed by 0.5 mg/min over 18 hours Maintenance Dose * Oral: at least 200 mg/day to be continued until 60 days after randomization * If drug cannot be given orally or via NG tube: 0.5 mg/min administered through central line (e.g., PICC) until oral dosing is started

DC-cardioversionPROCEDURE

DC-Cardioversion - frequency and duration determined by medical professional as medically needed

Rate ControlDRUG

Beta-blocker and/or Calcium channel blockers and/or Digoxin - Dose, frequency and duration determined by medical professional as medically needed

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Enrollment Inclusion Criteria: * Age \> 18 years * Undergoing heart surgery for coronary artery bypass (on-pump or off-pump CABG) and/or valve repair or replacement (excluding mechanical valves), including re-operations * Hemodynamically stable Randomization Inclusion Criteria * AF that persists for \> 60 minutes or recurrent (more than one) episodes of AF up to 7 days after surgery during the index hospitalization. Exclusion Criteria: * LVAD insertion or heart transplantation * Maze procedure * TAVR * History of or planned mechanical valve replacement * Correction of complex congenital cardiac defect (excluding bicuspid aortic valve, atrial septal defect or PFO) * History of AF or AFL * History of AF or AFL ablation * Contraindications to warfarin or amiodarone * Need for long-term anticoagulation * Concurrent participation in an interventional (drug or device) trial

Locations (23)

University of Southern California

Los Angeles, California, United States

Outcomes

Primary Outcomes

Total Number of Days in Hospital

The total number of days in hospital for any hospitalization that occurs within 60 days of randomization to AF treatment strategy.

Time frame: Within 60 days of randomization

Secondary Outcomes

Time to Conversion to Sustained, Stable Non-AF Rhythm

Time frame: Up to index hospital discharge or 7 days post surgery, whichever came first

Heart Rhythm Comparison

Compare heart rhythm (number of patients in sustained, stable non-AF rhythm) between treatment arms at hospital discharge

Time frame: Hospital discharge

Heart Rhythm Comparison

Compare heart rhythm (patients in sustained, stable non-AF rhythm) between treatment arms at 30 days after randomization

Time frame: 30 days after randomization

Heart Rhythm Comparison

Compare heart rhythm (number of patients in sustained, stable non-AF rhythm) between treatment arms at 60 days after randomization

Time frame: 60 days after randomization

Length of Stay (Index Hospitalization)

Overall length of stay for the index hospitalization

Time frame: Within 60 days post surgery

Length of Stay (Rehospitalization, Including ED Visits)

Compare length of stay between groups for any cause and AF-related hospitalizations, including ED visits

Time frame: Within 60 days of randomization

Outpatient Interventions

Data from ClinicalTrials.gov

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