Evidence map›Paper›PMID 40433221›Full record

ReviewCJC open2025

Rhythm vs Rate Control Strategies for Perioperative Atrial Fibrillation After Noncardiac Surgery: A Systematic Review and Meta-analysis.

Michael Ke Wang, Ghazal Razeghi, Geethan Baskaran, Louis Park, Steffen Blum, Rachel Heo, Tina Stegmann, P J Devereaux, William F McIntyre, Jeff S Healey and 6 more

Abstract readReview
In one paragraph

Review in CJC open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Michael Ke WangDepartment of Medicine, McMaster University, Toronto, Canada.
Ghazal RazeghiMichael G. DeGroote School of Medicine, McMaster University, Toronto, Canada.
Geethan BaskaranPopulation Health Research Institute, McMaster University, Toronto, Canada.
Louis ParkTemerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Steffen BlumPopulation Health Research Institute, McMaster University, Toronto, Canada.
Rachel HeoTemerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Tina StegmannDepartment of Cardiology, Leipzig University Hospital, Leipzig, Germany.
P J DevereauxDepartment of Medicine, McMaster University, Toronto, Canada.
William F McIntyreDepartment of Medicine, McMaster University, Toronto, Canada.
Jeff S HealeyDepartment of Medicine, McMaster University, Toronto, Canada.
Michael PrystajeckyDepartment of Medicine, University of Saskatchewan, Saskatoon, Canada.
Rémi LeBlancCentre Hospitalier Universitaire Dr-Georges-L.-Dumont, Moncton, Canada.
Shannon M RuzyckiDepartment of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Mohamed PanjuDepartment of Medicine, McMaster University, Toronto, Canada.
Kiven VuongSchulich School of Medicine & Dentistry, Western University, London, Canada.
David ConenDepartment of Medicine, McMaster University, Toronto, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: For patients with perioperative atrial fibrillation (POAF) after noncardiac surgery, earlier conversion to sinus rhythm might improve outcomes. The efficacy of a rhythm vs rate control strategy for the acute management of POAF remains uncertain. Methods: We searched databases for randomized controlled trials (RCTs) and observational studies that included patients with POAF after noncardiac surgery and reported outcomes for patients acutely treated with a rhythm control strategy vs either a rate control or no treatment strategy. Studies were pooled using random effects models. Results: Of the observational studies, a rhythm control strategy was associated with higher conversion rates to sinus rhythm compared with a rate control or no treatment strategy (risk ratio [RR], 1.93; 95% confidence interval [CI], 1.25-2.97; 9 studies; N = 591). Compared with a rate control or no treatment strategy, a rhythm control strategy was not associated with differences in length of hospital stay (mean difference, -1.67 days; 95% CI, -7.10 to 3.76; 2 studies), length of intensive care stay (mean difference, -1.90 days; 95% CI, -7.62 to 3.82; 1 study), or all-cause mortality (RR, 1.12; 95% CI, 0.62-2.00; 5 studies). In an RCT that compared amiodarone vs magnesium, the RR was 0.56 for conversion to sinus rhythm (95% CI, 0.31-1.03; N = 34). Conclusions: A rhythm control strategy was associated with greater success rates for conversion to sinus rhythm compared with a rate control or no treatment strategy. However, the observational studies were of low quality and only 1 small RCT was identified, and few data were available for other outcomes.

Identifiers

PMID40433221
PMCPMC12105477

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.