Rate Control Versus Rhythm Control For Postoperative Atrial Fibrillation

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.

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