No Advantage for Rhythm Control in Post-Cardiac Surgery AF

This meta-analysis clarifies that rhythm control offers no length-of-stay, thromboembolic, or mortality benefit over rate control for postoperative atrial fibrillation, while aggressive antiarrhythmics raise hemodynamic harm.

📅 Journal publication: 2026 (online Jul 14, 2026) · Last updated: Jul 30, 2026

amiodaroneibutilideprocainamidepropafenonesotalolflecainidemetoprololdiltiazemdigoxinverapamilrate controlrhythm controlpostoperative atrial fibrillationcardiac surgeryanticoagulationmeta-analysissystematic review Cardiology

Also in Perioperative / Anesthesia

Background Information

Rhythm control offers no clear advantage over rate control post-cardiac surgery.

Postcardiac surgery atrial fibrillation can affect recovery and outcomes, necessitating effective treatment strategies. No significant difference in hospital stay was found; rhythm control improved sinus rhythm but increased adverse events versus rate control. Rhythm control strategies may offer conversion benefits but come with higher risks, suggesting limited advantage over rate control in this setting. Rhythm control does not outperform rate control in improving outcomes post cardiac surgery.

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Authors: Dairi MS, Tarabzoni M, Tarola C, Sehmbi H, Alwafi H, Alghamdi SM, Khan S, Alotaibi WT, Hegazy AF

Citation: Dairi MS, Tarabzoni M, Tarola C, et al. Rhythm vs. rate control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Frontiers in cardiovascular medicine. 2026;13:1820175. doi:10.3389/fcvm.2026.1820175

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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