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document
Patterns of management of atrial fibrillation complicating coronary artery bypass grafting : Results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV ( PREVENT-IV ) Trial . BACKGROUND Current practice related to the management of atrial fibrillation ( AF ) complicating coronary artery bypass grafting ( CABG ) is uncertain . METHODS We examined management of post-CABG AF in the PREVENT-IV trial , and we explored patterns of use of postoperative rhythm versus rate control and anticoagulation for AF by geographic region and type of site . We also compared outcomes of patients who developed post-CABG AF ( 663 ) with those who did not ( 2,131 ) . RESULTS The incidence of AF was 24 % . Post-CABG AF was treated with a rhythm control strategy in 81 % of patients and with warfarin in 23 % of patients . Although there were significant variations across sites in the management of post-CABG AF , patterns of use of postoperative rhythm versus rate control and anticoagulation did not differ by geographic region or by whether or not the enrolling site was an academic institution . Mortality was higher in patients with post-CABG AF than patients without AF at 30 days ( 1.5 % vs 0.7 % , P = .01 ) but not at 3 years ( 6.9 % vs 4.9 % , P = .41 ) . There was a trend toward a higher risk of mortality or stroke at 30 days in patients with AF ( 2.4 % vs 1.9 % , P = .08 ) . CONCLUSION Although a rhythm control strategy was used in most of the patients in this trial and the overall rate of use of warfarin was low , the significance of these findings is uncertain because of the lack of data from randomized clinical trials . The substantial variations in the management of post-CABG AF across sites are likely because of definitive data on the most effective therapies , highlighting the need for clinical trials on rate versus rhythm control and on anticoagulation for AF in this setting .
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Intervention_Pharmacological
warfarin
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Outcome_Physical
atrial fibrillation ( AF )
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Outcome_Physical
AF
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Outcome_Physical
AF
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Outcome_Physical
Post-CABG AF
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Outcome_Physical
post-CABG AF
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Outcome_Mortality
Mortality
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Outcome_Mortality
mortality
42427
Outcome_Physical
stroke
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Participant_Condition
atrial fibrillation
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Participant_Condition
AF
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Participant_Condition
post-CABG AF
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Participant_Sample-size
663
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Participant_Sample-size
2,131