713 lines
320 KiB
Text
713 lines
320 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK571341">
|
|
<meta name="ncbi_domain" content="niceng196er13">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK571341/?report=reader">
|
|
<meta name="ncbi_pagename" content="Treatment strategies for atrial fibrillation after cardiothoracic surgery - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Treatment strategies for atrial fibrillation after cardiothoracic surgery - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX">
|
|
<meta name="author" content="National Guideline Centre (UK)">
|
|
<meta name="citation_title" content="Treatment strategies for atrial fibrillation after cardiothoracic surgery">
|
|
<meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="citation_date" content="2021/04">
|
|
<meta name="citation_author" content="National Guideline Centre (UK)">
|
|
<meta name="citation_pmid" content="34165940">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK571341/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Treatment strategies for atrial fibrillation after cardiothoracic surgery">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="DC.Contributor" content="National Guideline Centre (UK)">
|
|
<meta name="DC.Date" content="2021/04">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK571341/">
|
|
<meta name="og:title" content="Treatment strategies for atrial fibrillation after cardiothoracic surgery">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK571341/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng196er13-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/niceng196er13/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK571341/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8D325D7D71728100000000006E0048.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK571341/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK571341/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK571341/&text=Treatment%20strategies%20for%20atrial%20fibrillation%20after%20cardiothoracic%20surgery"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a class="current">Title Information</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK571341/?report=classic">Switch to classic view</a><a href="/books/n/niceng196er13/pdf/">PDF (1.7M)</a><a href="/books/n/niceng196er13/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK571341%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8D325D7D71728100000000006E0048.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng196er13-lrg.png" alt="Cover of Treatment strategies for atrial fibrillation after cardiothoracic surgery" /></a></div><div class="bkr_bib"><h1 id="_NBK571341_"><span itemprop="name">Treatment strategies for atrial fibrillation after cardiothoracic surgery</span></h1><div class="subtitle">Atrial fibrillation: diagnosis and management</div><p><b>Evidence review L</b></p><p><i>NICE Guideline, No. 196</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Apr</span>.</div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng196er13.s1"><h2 id="_niceng196er13_s1_">1. Treatment strategies for atrial fibrillation after cardiothoracic surgery</h2><div id="niceng196er13.s1.1"><h3>1.1. Review question: What is the most clinical and cost effective treatment strategy (rate or rhythm control,or no treatment) for peoplewith atrial fibrillation after cardiothoracic surgery?</h3></div><div id="niceng196er13.s1.2"><h3>1.2. Introduction</h3><p>Atrial fibrillation remains one of the most common adverse events to occur following cardiac surgery. Despite the improvement in the rate of other perioperative morbidities and mortality, however, the reported incidence of post-operative AF following cardiac surgery remains high (up to 30–50%) and has not changed significantly over recent years. Its incidence increases in those with an increased age, undergoing surgery of increased complexity or with a past history of AF, and is associated with a significant increase in perioperative morbidity, hospital length of stay, utilisation of health care resources and mortality.</p><p>The exact mechanisms of initiation and maintenance of post-cardiac surgery AF, however, are not fully understood and associated with this, a number of different treatment modalities and strategies (rate or rhythm control) have been proposed. A rate control strategy includes using medications (such as beta-blockers or calcium channel blockers) that reduce conduction across the atrioventricular node to slow the heart rate, whereas rhythm control strategies include using pharmacological agents (such as amiodarone) or electrical cardioversion in an attempt to restore sinus rhythm. Other considerations for these patients include identification and treatment of any triggers of atrial fibrillation, such as restoration of serum potassium and magnesium levels; anticoagulation, whilst balancing bleeding risks with thromboembolic risks; and the haemodynamic status of the patient, where early electrical cardioversion may be required in patients with hypotension or marked tachycardia.</p><p>Due to the absence of robust clinical studies, the implementation of these different management strategies varies considerably. This chapter intends to examine the clinical evidence surrounding the different therapeutic options used in the treatment of atrial fibrillation following cardiac surgery and develop some recommendations regarding how best to manage these patients.</p></div><div id="niceng196er13.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng196er13.appa">Appendix A</a>:.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab1"><a href="/books/NBK571341/table/niceng196er13.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab1" rid-ob="figobniceng196er13tab1"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab1/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab1"><a href="/books/NBK571341/table/niceng196er13.tab1/?report=objectonly" target="object" rid-ob="figobniceng196er13tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng196er13.s1.4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er13.ref83" rid="niceng196er13.ref83"><sup>83</sup></a>Methods specific to this review question are described in the review protocol in <a href="#niceng196er13.appa">Appendix A</a>:.</p></div><div id="niceng196er13.s1.5"><h3>1.5. Clinical evidence</h3><div id="niceng196er13.s1.5.1"><h4>1.5.1. Included studies</h4><p>A search was conducted to identify randomised controlled trials or systematic reviews of randomised controlled trials comparing different strategies for treating atrial fibrillation after cardiothoracic surgery, including rate control (beta-blockers, calcium channel blockers, digoxin and amiodarone), rhythm control (Na+ blockers, K+ blockers and DC cardioversion) and no treatment strategies. The population could include those developing atrial fibrillation after surgery and also those with pre-existing atrial fibrillation prior to the surgery – population strata were used to stratify for the presence or absence of pre-existing atrial fibrillation prior to surgery from the outset of the review. Fifteen studies (from sixteen papers) were included in the review;<a class="bibr" href="#niceng196er13.ref12" rid="niceng196er13.ref12"><sup>12</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref13" rid="niceng196er13.ref13"><sup>13</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref15" rid="niceng196er13.ref15"><sup>15</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref31" rid="niceng196er13.ref31"><sup>31</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref35" rid="niceng196er13.ref35"><sup>35</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref37" rid="niceng196er13.ref37"><sup>37</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref51" rid="niceng196er13.ref51"><sup>51</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref64" rid="niceng196er13.ref64"><sup>64</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref67" rid="niceng196er13.ref67"><sup>67</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref68" rid="niceng196er13.ref68"><sup>68</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref84" rid="niceng196er13.ref84"><sup>84</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref89" rid="niceng196er13.ref89"><sup>89</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref100" rid="niceng196er13.ref100"><sup>100</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref101" rid="niceng196er13.ref101"><sup>101</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref110" rid="niceng196er13.ref110"><sup>110</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref111" rid="niceng196er13.ref111"><sup>111</sup></a> these are summarised in <a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab2/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab2" rid-ob="figobniceng196er13tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab3/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab3" rid-ob="figobniceng196er13tab3">Tables 3</a>-<a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab17/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab17" rid-ob="figobniceng196er13tab17">17</a>).</p><p>See also the study selection flow chart in <a href="#niceng196er13.appc">Appendix C</a>:, study evidence tables in <a href="#niceng196er13.appd">Appendix D</a>:, forest plots in <a href="#niceng196er13.appe">Appendix E</a>:andGRADE tables in <a href="#niceng196er13.appf">Appendix F</a>:.</p><p>The majority of studies (eleven studies from twelve papers) included in this review were within the no pre-existing atrial fibrillation stratum, where in most cases the presence of atrial fibrillation prior to the cardiothoracic surgery was an exclusion criterion. Of the remaining four papers, three were within the pre-existing atrial fibrillation stratum and one was assigned to the mixed/unclear stratum as there were limited details to assign it to one of the two other strata.</p><p>The included studies covered the following comparisons between the interventions listed in the protocol for this review:</p><p>Mixed/unclear stratum:
|
|
<ul><li class="half_rhythm"><div>One study compared calcium channel blockers (intravenous verapamil) with intravenous placebo;<a class="bibr" href="#niceng196er13.ref37" rid="niceng196er13.ref37"><sup>37</sup></a></div></li></ul></p><p>No pre-existing AF stratum:
|
|
<ul><li class="half_rhythm"><div>One study compared DC cardioversion with K+ blockers (intravenous amiodarone);<a class="bibr" href="#niceng196er13.ref31" rid="niceng196er13.ref31"><sup>31</sup></a></div></li><li class="half_rhythm"><div>One study compared K+ blockers (intravenous amiodarone) with intravenous digoxin;<a class="bibr" href="#niceng196er13.ref15" rid="niceng196er13.ref15"><sup>15</sup></a></div></li><li class="half_rhythm"><div>Two studies compared K+ blockers (intravenous followed by oral amiodarone) with K+ blockers + ranolazine (intravenous amiodarone and oral ranolazine, followed by oral amiodarone and oral ranolazine);<a class="bibr" href="#niceng196er13.ref100" rid="niceng196er13.ref100"><sup>100</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref101" rid="niceng196er13.ref101"><sup>101</sup></a></div></li><li class="half_rhythm"><div>One study compared a mixed rate control strategy (specific drugs not stated, oral administration likely but not clear) with K+ blockers (amiodarone recommended, oral administration) +/-a rate control agent (specific drugs not stated, oral administration likely but not clear);<a class="bibr" href="#niceng196er13.ref35" rid="niceng196er13.ref35"><sup>35</sup></a></div></li><li class="half_rhythm"><div>One study (covered by two papers) compared a mixed rhythm control strategy (such as sotalol, propafenone or procainamide, route of administration dependent on drug used) +/- electrical cardioversion with a mixed rate control strategy (such as diltiazem, verapamil, metoprolol, atenolol, propranolol, esmolol or digoxin - route of administration dependent on drug used and patient);<a class="bibr" href="#niceng196er13.ref67" rid="niceng196er13.ref67"><sup>67</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref68" rid="niceng196er13.ref68"><sup>68</sup></a></div></li><li class="half_rhythm"><div>One study compared Na+ blockers (intravenous flecainide) with intravenous digoxin<a class="bibr" href="#niceng196er13.ref111" rid="niceng196er13.ref111"><sup>111</sup></a></div></li><li class="half_rhythm"><div>One study compared Na+ blockers (oral propafenone) with K+ blockers (intravenous amiodarone);<a class="bibr" href="#niceng196er13.ref84" rid="niceng196er13.ref84"><sup>84</sup></a></div></li><li class="half_rhythm"><div>One study compared calcium channel blockers(intravenous verapamil)with intravenous placebo;<a class="bibr" href="#niceng196er13.ref51" rid="niceng196er13.ref51"><sup>51</sup></a></div></li><li class="half_rhythm"><div>One study compared K+ blockers (intravenous vernakalant) with intravenous placebo;<a class="bibr" href="#niceng196er13.ref64" rid="niceng196er13.ref64"><sup>64</sup></a></div></li><li class="half_rhythm"><div>One study compared K+ blockers (amiodarone) with routine medical treatment alone;<a class="bibr" href="#niceng196er13.ref12" rid="niceng196er13.ref12"><sup>12</sup></a></div></li></ul></p><p>Pre-existing AF stratum:
|
|
<ul><li class="half_rhythm"><div>One study compared DC cardioversion (oral amiodarone for four days prior to cardioversion) with K+ blockers + captopril + simvastatin (oral amiodarone with captopril and simvastatin);<a class="bibr" href="#niceng196er13.ref13" rid="niceng196er13.ref13"><sup>13</sup></a></div></li><li class="half_rhythm"><div>One study compared a mixed rate control strategy (digoxin and/or diltiazem, route unclear but likely to be oral based on study length) with K+ blockers + captopril + simvastatin(oral amiodarone with captopril and simvastatin);<a class="bibr" href="#niceng196er13.ref89" rid="niceng196er13.ref89"><sup>89</sup></a></div></li><li class="half_rhythm"><div>One study compared K+ blockers(intravenous followed by oral amiodarone) + DC cardioversion with placebo (unclear if given intravenously followed by orally as with amiodarone) + DC cardioversion;<a class="bibr" href="#niceng196er13.ref110" rid="niceng196er13.ref110"><sup>110</sup></a></div></li></ul></p><p>It is also noted that studies which included intravenous use of certain drugs (including diltiazem, sotalol, disopyramide and propafenone) that are only available in the UK in oral form and not used intravenously were not included in the review. One study(from two papers)that compared a mixed rhythm control strategy +/- electrical cardioversion with a mixed rate control strategy was downgraded for intervention indirectness, as one of the options within the mixed rate control strategy was the use of intravenous diltiazem but the proportion of patients that received this as their rate control strategy was unclear<a class="bibr" href="#niceng196er13.ref67" rid="niceng196er13.ref67"><sup>67</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#niceng196er13.ref68" rid="niceng196er13.ref68"><sup>68</sup></a>.</p></div><div id="niceng196er13.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng196er13.appi">Appendix I</a>:.</p></div><div id="niceng196er13.s1.5.3"><h4>1.5.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab2"><a href="/books/NBK571341/table/niceng196er13.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab2" rid-ob="figobniceng196er13tab2"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab2/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab2"><a href="/books/NBK571341/table/niceng196er13.tab2/?report=objectonly" target="object" rid-ob="figobniceng196er13tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng196er13.appd">Appendix D</a>:for full evidence tables.</p></div><div id="niceng196er13.s1.5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab3"><a href="/books/NBK571341/table/niceng196er13.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab3" rid-ob="figobniceng196er13tab3"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab3/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: Evidence not suitable for GRADE analysis." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab3"><a href="/books/NBK571341/table/niceng196er13.tab3/?report=objectonly" target="object" rid-ob="figobniceng196er13tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Evidence not suitable for GRADE analysis. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab4"><a href="/books/NBK571341/table/niceng196er13.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab4" rid-ob="figobniceng196er13tab4"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab4/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Mixed/unclear stratum– calcium channel blockers vs. placebo." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab4"><a href="/books/NBK571341/table/niceng196er13.tab4/?report=objectonly" target="object" rid-ob="figobniceng196er13tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Mixed/unclear stratum– calcium channel blockers vs. placebo. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab5"><a href="/books/NBK571341/table/niceng196er13.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab5" rid-ob="figobniceng196er13tab5"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab5/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: No pre-existing AFstratum– DC cardioversion vs. K+ blockers." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab5"><a href="/books/NBK571341/table/niceng196er13.tab5/?report=objectonly" target="object" rid-ob="figobniceng196er13tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AFstratum– DC cardioversion vs. K+ blockers. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab6"><a href="/books/NBK571341/table/niceng196er13.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab6" rid-ob="figobniceng196er13tab6"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab6/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: No pre-existing AFstratum– K+ blockers vs. digoxin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab6"><a href="/books/NBK571341/table/niceng196er13.tab6/?report=objectonly" target="object" rid-ob="figobniceng196er13tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AFstratum– K+ blockers vs. digoxin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab7"><a href="/books/NBK571341/table/niceng196er13.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab7" rid-ob="figobniceng196er13tab7"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab7/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: No pre-existing AF stratum– K+ blockers vs. K+ blockers + ranolazine." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab7"><a href="/books/NBK571341/table/niceng196er13.tab7/?report=objectonly" target="object" rid-ob="figobniceng196er13tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– K+ blockers vs. K+ blockers + ranolazine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab8"><a href="/books/NBK571341/table/niceng196er13.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab8" rid-ob="figobniceng196er13tab8"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab8/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab8/?report=previmg" alt="Table 8. Clinical evidence summary: No pre-existing AF stratum– mixed rate control vs. K+ blockers with/without rate control agent." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab8"><a href="/books/NBK571341/table/niceng196er13.tab8/?report=objectonly" target="object" rid-ob="figobniceng196er13tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– mixed rate control vs. K+ blockers with/without rate control agent. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab9"><a href="/books/NBK571341/table/niceng196er13.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab9" rid-ob="figobniceng196er13tab9"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab9/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab9/?report=previmg" alt="Table 9. Clinical evidence summary: No pre-existing AF stratum– mixed rhythm control +/- electrical cardioversion vs. mixed rate control." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab9"><a href="/books/NBK571341/table/niceng196er13.tab9/?report=objectonly" target="object" rid-ob="figobniceng196er13tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– mixed rhythm control +/- electrical cardioversion vs. mixed rate control. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab10"><a href="/books/NBK571341/table/niceng196er13.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab10" rid-ob="figobniceng196er13tab10"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab10/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab10/?report=previmg" alt="Table 10. Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. digoxin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab10"><a href="/books/NBK571341/table/niceng196er13.tab10/?report=objectonly" target="object" rid-ob="figobniceng196er13tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. digoxin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab11"><a href="/books/NBK571341/table/niceng196er13.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab11" rid-ob="figobniceng196er13tab11"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab11/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab11/?report=previmg" alt="Table 11. Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. K+ blockers." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab11"><a href="/books/NBK571341/table/niceng196er13.tab11/?report=objectonly" target="object" rid-ob="figobniceng196er13tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. K+ blockers. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab12"><a href="/books/NBK571341/table/niceng196er13.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab12" rid-ob="figobniceng196er13tab12"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab12/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab12/?report=previmg" alt="Table 12. Clinical evidence summary: No pre-existing AFstratum– Calcium channel blockers vs. placebo." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab12"><a href="/books/NBK571341/table/niceng196er13.tab12/?report=objectonly" target="object" rid-ob="figobniceng196er13tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AFstratum– Calcium channel blockers vs. placebo. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab13"><a href="/books/NBK571341/table/niceng196er13.tab13/?report=objectonly" target="object" title="Table 13" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab13" rid-ob="figobniceng196er13tab13"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab13/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab13/?report=previmg" alt="Table 13. Clinical evidence summary: No pre-existing AFstratum– K+ blockers (vernakalant) vs. placebo." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab13"><a href="/books/NBK571341/table/niceng196er13.tab13/?report=objectonly" target="object" rid-ob="figobniceng196er13tab13">Table 13</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AFstratum– K+ blockers (vernakalant) vs. placebo. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab14"><a href="/books/NBK571341/table/niceng196er13.tab14/?report=objectonly" target="object" title="Table 14" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab14" rid-ob="figobniceng196er13tab14"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab14/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab14/?report=previmg" alt="Table 14. Clinical evidence summary: No pre-existing AF stratum– K+ blockers (amiodarone) vs. routine medical treatment alone." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab14"><a href="/books/NBK571341/table/niceng196er13.tab14/?report=objectonly" target="object" rid-ob="figobniceng196er13tab14">Table 14</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No pre-existing AF stratum– K+ blockers (amiodarone) vs. routine medical treatment alone. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab15"><a href="/books/NBK571341/table/niceng196er13.tab15/?report=objectonly" target="object" title="Table 15" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab15" rid-ob="figobniceng196er13tab15"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab15/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab15/?report=previmg" alt="Table 15. Clinical evidence summary: Pre-existing AF stratum– DC cardioversion vs. K+ blockers + captopril + simvastatin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab15"><a href="/books/NBK571341/table/niceng196er13.tab15/?report=objectonly" target="object" rid-ob="figobniceng196er13tab15">Table 15</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Pre-existing AF stratum– DC cardioversion vs. K+ blockers + captopril + simvastatin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab16"><a href="/books/NBK571341/table/niceng196er13.tab16/?report=objectonly" target="object" title="Table 16" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab16" rid-ob="figobniceng196er13tab16"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab16/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab16/?report=previmg" alt="Table 16. Clinical evidence summary: Pre-existing AF stratum– Mixed rate control vs. K+ blockers + captopril + simvastatin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab16"><a href="/books/NBK571341/table/niceng196er13.tab16/?report=objectonly" target="object" rid-ob="figobniceng196er13tab16">Table 16</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Pre-existing AF stratum– Mixed rate control vs. K+ blockers + captopril + simvastatin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab17"><a href="/books/NBK571341/table/niceng196er13.tab17/?report=objectonly" target="object" title="Table 17" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab17" rid-ob="figobniceng196er13tab17"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab17/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab17/?report=previmg" alt="Table 17. Clinical evidence summary: Pre-existing AF stratum– K+ blockers + DC cardioversion vs. placebo + DC cardioversion." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab17"><a href="/books/NBK571341/table/niceng196er13.tab17/?report=objectonly" target="object" rid-ob="figobniceng196er13tab17">Table 17</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Pre-existing AF stratum– K+ blockers + DC cardioversion vs. placebo + DC cardioversion. </p></div></div><p>See <a href="#niceng196er13.appf">Appendix F</a>: for full GRADE tables.</p><p>Click here to enter text.</p></div></div><div id="niceng196er13.s1.6"><h3>1.6. Economic evidence</h3><div id="niceng196er13.s1.6.1"><h4>1.6.1. Included studies</h4><p>No health economic studies were included.</p></div><div id="niceng196er13.s1.6.2"><h4>1.6.2. Excluded studies</h4><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng196er13.appg">Appendix G</a>:.</p></div><div id="niceng196er13.s1.6.3"><h4>1.6.3. Unit costs</h4><p>Relevant drug unit costs are provided in <a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab18/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab18" rid-ob="figobniceng196er13tab18">Table 18</a> to aid consideration of costeffectiveness.</p><p>Note, the Na+ channel blocker procainamide is only available from ‘special-order’ manufacturers or specialist importing companies and so has not been costed below.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab18"><a href="/books/NBK571341/table/niceng196er13.tab18/?report=objectonly" target="object" title="Table 18" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab18" rid-ob="figobniceng196er13tab18"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab18/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab18/?report=previmg" alt="Table 18. Drug unit costs." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab18"><a href="/books/NBK571341/table/niceng196er13.tab18/?report=objectonly" target="object" rid-ob="figobniceng196er13tab18">Table 18</a></h4><p class="float-caption no_bottom_margin">Drug unit costs. </p></div></div><p>Direct current cardioversion (X501) and external cardioversion electrical cardioversion (X502) are not coded separately as a HRG, and therefore the day case unit cost for Arrhythmia or Conduction Disorders (EB07) is the closest proxy, which has a weighted cost of £670taking comorbidities and or complications into account.<a class="bibr" href="#niceng196er13.ref22" rid="niceng196er13.ref22"><sup>22</sup></a></p><p>The weighted average cost for excess bed days for patients who have had elective and non-elective CABG are provided in <a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab19/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab19" rid-ob="figobniceng196er13tab19">Table 19</a> and <a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab20/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab20" rid-ob="figobniceng196er13tab20">Table 20</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab19"><a href="/books/NBK571341/table/niceng196er13.tab19/?report=objectonly" target="object" title="Table 19" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab19" rid-ob="figobniceng196er13tab19"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab19/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab19/?report=previmg" alt="Table 19. Elective inpatient excess bed days cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab19"><a href="/books/NBK571341/table/niceng196er13.tab19/?report=objectonly" target="object" rid-ob="figobniceng196er13tab19">Table 19</a></h4><p class="float-caption no_bottom_margin">Elective inpatient excess bed days cost. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er13tab20"><a href="/books/NBK571341/table/niceng196er13.tab20/?report=objectonly" target="object" title="Table 20" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er13tab20" rid-ob="figobniceng196er13tab20"><img class="small-thumb" src="/books/NBK571341/table/niceng196er13.tab20/?report=thumb" src-large="/books/NBK571341/table/niceng196er13.tab20/?report=previmg" alt="Table 20. Non-elective inpatient excess bed days cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er13.tab20"><a href="/books/NBK571341/table/niceng196er13.tab20/?report=objectonly" target="object" rid-ob="figobniceng196er13tab20">Table 20</a></h4><p class="float-caption no_bottom_margin">Non-elective inpatient excess bed days cost. </p></div></div></div></div><div id="niceng196er13.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="niceng196er13.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng196er13.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>In this review, the following outcomes were considered to be critical for decision-making: health-related quality of life, mortality, stroke or thromboembolic complications, need for rescue DC cardioversion, rehospitalisation (all-cause), rehospitalisation for AF, achievement of sinus rhythm and adverse events.</p><p>Additional outcomes that were considered to be important for decision-making were freedom from anticoagulation, freedom from antiarrhythmic drug use, hospital length of stay and intensive care unit length of stay.</p><p>In this review, no clinical evidence was identified for the following critical outcomes: freedom from antiarrhythmic drug use and intensive care unit length of stay.</p></div><div id="niceng196er13.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>The quality of the evidence for all outcomes included in this review ranged from very low quality to moderate, with the majority of outcomes for all comparisons being rated very low quality based on GRADE quality assessment. For those rated very low quality, the main factors contributing to the quality rating were a very high or high risk of bias and imprecision in the effect estimates due to very small study sample sizes. There were only four studies where the population size was >100 participants, and the number of participants within the other nine studies ranged from 14 to 99, which made imprecision an issue with the majority of outcomes from these smaller studies. This made it difficult for the committee to interpret these outcomes and decide whether any clinically important differences were present due to the uncertainty surrounding the effect estimates. For the majority of outcomes only one study was available and meta-analysis was therefore not performed.</p><p>In addition, there were some outcomes presented that could not be analysed and assessed by GRADE due to insufficient detail reported within the studies. This comprised two outcomes, one where only the median and interquartile range was given for the length of hospital stay in both groups and the other where data was not given for separately for each randomised group. These outcomes were reported separate to other outcomes and are presented in <a class="figpopup" href="/books/NBK571341/table/niceng196er13.tab3/?report=objectonly" target="object" rid-figpopup="figniceng196er13tab3" rid-ob="figobniceng196er13tab3">Table 3</a> of the evidence review.</p></div><div id="niceng196er13.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>The evidence included in this review was obtained from thirteen RCTs (covered by fourteen papers) and was stratified from the outset based on whether or not the AF was pre-existing before cardiothoracic surgery was performed within the individual studies.</p><p>For the no pre-existing AF stratum, where AF was new-onset following cardiothoracic surgery, nine RCTs were included, which covered the following comparisons: DC cardioversion vs. K+ blockers, K+ blockers vs. digoxin, K+ blockers vs. K+ blockers + ranolazine, mixed rate control vs. K+ blockers with/without rate control, mixed rhythm control with/without electrical cardioversion vs. mixed rate control, Na+ blockers vs. digoxin, Na+ blockers vs. K+ blockers and calcium channel blockers vs. placebo.</p><p>For the pre-existing AF stratum, where AF was present prior to the cardiothoracic surgery, three RCTs were included, which covered the following comparisons: DC cardioversion vs. K+ blockers + captopril + simvastatin, mixed rate control vs. K+ blockers + captopril + simvastatin and K+ blockers + DC cardioversion vs. placebo + DC cardioversion.</p><p>There was an additional study that could not be classified into either of the above strata as there was no information about preoperative AF – this was included separately under a mixed/unclear stratum and covered the comparison between calcium channel blockers and placebo.</p><div id="niceng196er13.s1.7.1.3.1"><h5>No pre-existing AF</h5><p>For the majority of the evidence within this stratum, the committee agreed that there was insufficient evidence to favour particular interventions and that many of the studies were old with very small participant numbers and covered drugs that are not commonly used in practice anymore. For the comparisons between individual drug classes (such as Na+ blockers vs. K+ blockers) there was only one, small study for each and there was substantial uncertainty in the effect estimate for most outcomes due to imprecision, meaning the committee felt that there was insufficient evidence to favour a particular drug class.</p><p>However, the committee noted the inclusion of a larger RCT that compared a mixed rate control strategy vs. K+ blockers (amiodarone) with/without rate control that reported numerous outcomes listed in the protocol, all of which appeared to suggest no clinical difference (or there was uncertainty around the effect estimate and the true effect size) between the two groups, particularly concerning the presence of sinus rhythm at discharge, freedom from warfarin at discharge and all-cause hospital readmission at 60 days. There was also no difference in hospital length of stay based on median values reported in the study.</p><p>There were some outcomes where the point estimate of the relative effect suggested a benefit of K+ blockers with/without rate control (mortality and stroke or thromboembolic complications); however the committee did not consider these to be clinically important differences based on the absolute effect estimates, the presence of imprecision and the low number of events. The adverse event outcome (serious and non-serious events) reported in this study appeared to suggest a slight benefit of mixed rate control, which the committee agreed may be due to the side effects associated with amiodarone use, however this was also considered not to be a clinically important difference based on the size of the effect. Need for rescue DC cardioversion also suggested a benefit of mixed rate control over amiodarone treatment, however, DC cardioversion was a recommended procedure in the amiodarone group if patients did not respond (and this was not mentioned within the mixed rate control group procedure), which may partially explain the increased number in the amiodarone group.</p><p>Although this RCT was not without its limitations, such as no details provided about the types of rate control drugs included in the mixed rate control group, the committee noted that this was the best available evidence within the review to inform changes to the existing recommendation covering the post-cardiothoracic surgery population.</p><p>Overall, the committee considered that for those with no pre-existing AF prior to cardiothoracic surgery, there was insufficient evidence to keep the existing strong recommendation to offer a rhythm control strategy as the initial management option for postoperative atrial fibrillation following cardiothoracic surgery, and therefore agreed that this should be changed to a consider recommendation, which would give less emphasis on rhythm control strategies and allow rate control strategies to be considered if the clinician felt this was more appropriate for the individual patient. The committee agreed that this may lead to a change in practice as in their experience the use of amiodarone to treat new-onset AF following cardiothoracic surgery is routine. The committee noted that this routine use of amiodarone may be unnecessary based on the results of the review and the possibility that postoperative AF may resolve naturally in many patients with watchful waiting, meaning that a rate control strategy rather than a rhythm control strategy may often be sufficient to resolve the atrial fibrillation. This contributed to the committee’s decision to change the recommendation to a consider recommendation. The committee also noted that if a rate control strategy was initially selected instead of a rhythm control strategy, rhythm control would remain an option if this initial management failed. A benefit of a watchful waiting strategy could include avoiding side effects associated with rate and rhythm control drugs (particularly amiodarone), though side effects are considered to be less of an issue with the short term use of these drugs. However, limited evidence was included in this review comparing rate or rhythm control drugs with a watchful waiting strategy, and therefore no recommendation was made concerning this strategy.</p><p>The committee agreed that if a rhythm control strategy was chosen as the initial management, the need for this should be reviewed, alongside the need for any associated anticoagulation, at approximately 6 weeks and not continued automatically for long periods of time. 6 weeks is in line with current practice and is an appropriate time point to assess the person’s recovery including for example prosthetic valve function and to check if sinus rhythm has been restored. The committee agreed that the adverse events associated with the use of amiodarone are usually following medium to long-term use and were less concerned about these adverse events for the treatment of new-onset AF following cardiothoracic surgery, providing amiodarone use is not continued for long periods unnecessarily.</p></div><div id="niceng196er13.s1.7.1.3.2"><h5>Pre-existing AF</h5><p>The committee agreed that there was insufficient evidence within this stratum to make any specific recommendations for those with pre-existing AF before cardiothoracic surgery that remained following surgery. The evidence was obtained from three studies, which covered three separate comparisons.</p><p>There was some evidence from one study that DC cardioversion improved clinical outcomes compared with a group where K+ blockers were used, and evidence from another study that suggested K+ blockers with DC cardioversion was better than DC cardioversion alone in terms of achieving sinus rhythm. However, these studies were substantially smaller than the largest RCT included for the no pre-existing AF stratum and the committee felt unable to make recommendations based on his.</p><p>In addition to the lack of evidence, the committee noted that all three studies in this stratum covered the patients that were undergoing mitral valve surgery and that in this situation most patients with pre-existing AF prior to mitral valve surgery would undergo simultaneous left atrial surgery at the time of valve intervention, with the aim of resolving the AF and reducing the need for future intervention or treatment.</p></div></div></div><div id="niceng196er13.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>No relevant health economic analyses were identified for this review. Relevant unit costs were presented for rate and rhythm strategies. The unit cost of rate and rhythm drugs was generally low and comparable. Although there were some more costly drugs within each class, these were considered by the committee to be less frequently used than the other lower cost drugs. This was because the low cost drugs generally work well in terms of acute conversion and there is no evidence of any gains of using the more expensive drugs currently. Furthermore, the aim of this review question was to compare rate versus rhythm strategies rather than making inter class comparisons, therefore this was not considered an issue. Finally, the committee noted that rate or rhythm drugs would be used for a short period of time in this context, usually over a period of days or weeks. The unit cost of direct current cardioversion was also presented. Direct current cardioversion (X501) and external cardioversion electrical cardioversion (X502) are not coded separately as an HRG, and therefore the day case unit cost for Arrhythmia or Conduction Disorders (EB07) is the closest proxy, which has a weighted cost of £670 taking comorbidities and or complications into account. The committee noted that the cost would likely be lower when done in the intensive care unit or in an outpatient setting. Finally, the unit cost of excess bed days for patients undergoing CABG was presented to illustrate the potential cost of strategies that increase length of stay.</p><p>The committee considered these unit costs alongside the clinical evidence summarised above. For people with no pre-existing atrial fibrillation, they agreed that the limited clinical evidence available did not support the previous strong recommendation to offer rhythm control. Instead they made a weaker ‘consider’ recommendation reflecting the limited clinical evidence and lack of economic evidence. This was based primarily on a single large RCT which showed no difference between rate and rhythm strategies for a number of the protocol outcomes. This study included outcomes associated with resource use such as rehospitalisation and rescue direct current cardioversion. For all cause rehospitalisation, there was no difference between rate and rhythm strategies. For rescue cardioversion and AF rehospitalisation outcomes, they favoured rate control, however there was uncertainty surrounding the point estimate. Overall it was considered that this amendment to the recommendation may reduce the use of rhythm control with drugs such as amiodarone, and increase the use of rate control drugs. As the cost of the drugs is similar and there is no reported significant difference in downstream resource use from the clinical evidence, it was thought that this recommendation amendment is unlikely to have a significant resource impact.</p><p>For those with pre-existing AF, no specific recommendation was made for this population due to a lack of robust and relevant clinical evidence.</p></div><div id="niceng196er13.s1.7.3"><h4>1.7.3. Other factors the committee took into account</h4><p>The committee also considered the role of patient preference in the decision to use a rhythm or rate control strategy following the development of new-onset AF post-cardiothoracic surgery. The committee agreed that where possible the clinician would discuss with the patient their preferences, but also noted that in many cases the patient would be acutely unwell and unable to communicate their preferences to the clinician, meaning the clinician would have to make the decision without patient input in these cases.</p></div></div></div><div id="niceng196er13.rl.r1"><h2 id="_niceng196er13_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng196er13.ref1">Anonymous. Managing atrial fibrillation after coronary artery bypass graft surgery involves prophylaxis, cardioversion and/or ventricular rate control. Drugs and Therapy Perspectives. 2006; 22(9):12–15</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng196er13.ref2">Balser
|
|
JR, Martinez
|
|
EA, Winters
|
|
BD, Perdue
|
|
PW, Clarke
|
|
AW, Huang
|
|
W
|
|
et al. Beta-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. Anesthesiology. 1998; 89(5):1052–1059 [<a href="https://pubmed.ncbi.nlm.nih.gov/9821992" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9821992</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng196er13.ref3">Banach
|
|
M, Okonski
|
|
P, Zaslonka
|
|
J. Atrial fibrillation following cardiosurgical operations - current guidelines of pharmacotherapy and invasive treatment. Polski Przeglad Chirurgiczny. 2005; 77(4):398–412</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng196er13.ref4">Bechtel
|
|
JF, Christiansen
|
|
JF, Sievers
|
|
HH, Bartels
|
|
C. Low-energy cardioversion versus medical treatment for the termination of atrial fibrillation after CABG. Annals of Thoracic Surgery. 2003; 75(4):1185–1188 [<a href="https://pubmed.ncbi.nlm.nih.gov/12683560" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12683560</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng196er13.ref5">Bernard
|
|
EO, Schmid
|
|
ER, Schmidlin
|
|
D, Scharf
|
|
C, Candinas
|
|
R, Germann
|
|
R. Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Critical Care Medicine. 2003; 31(4):1031–1034 [<a href="https://pubmed.ncbi.nlm.nih.gov/12682468" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12682468</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="niceng196er13.ref6">Blessberger
|
|
H, Lewis
|
|
S, Pritchard
|
|
M, Fawcett
|
|
L, Domanovits
|
|
H, Schlager
|
|
O
|
|
et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing cardiac surgery. Cochrane Database of Systematic Reviews
|
|
2019, Issue 9. Art. No.: CD013435. DOI: 10.1002/14651858.CD013435. [<a href="/pmc/articles/PMC6755267/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6755267</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31544227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31544227</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD013435" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="niceng196er13.ref7">BMJ Group and the Royal Pharmaceutical Society of Great Britain. British National Formulary. Available from: <a href="https://www.evidence.nhs.uk/formulary/bnf/current" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.evidence<wbr style="display:inline-block"></wbr>​.nhs.uk/formulary/bnf/current</a> Last accessed: 21/01/2020.</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng196er13.ref8">Bockeria
|
|
OL, Kanametov
|
|
TN, Shvartz
|
|
VA, Sokolskaya
|
|
MA, Zhuginisov
|
|
DS, Sanakoev
|
|
MK
|
|
et al. Epicardial application of hydrogel with amiodarone for prevention of postoperative atrial fibrillation in patients after coronary artery bypass grafting. Journal of Cardiovascular Translational Research. 2020; 13: 191–198 [<a href="https://pubmed.ncbi.nlm.nih.gov/31367901" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31367901</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="niceng196er13.ref9">Burke
|
|
SW, Solomon
|
|
AJ. Atrial fibrillation in patients after cardiovascular surgery: incidence, risk factors, preventive and therapeutic strategies. American Journal of Cardiovascular Drugs. 2003; 3(2):95–100 [<a href="https://pubmed.ncbi.nlm.nih.gov/14727936" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14727936</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng196er13.ref10">Campbell
|
|
TJ, Gavaghan
|
|
TP, Morgan
|
|
JJ. Intravenous sotalol for the treatment of atrial fibrillation and flutter after cardiopulmonary bypass. Comparison with disopyramide and digoxin in a randomised trial. British Heart Journal. 1985; 54(1):86–90 [<a href="/pmc/articles/PMC481854/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC481854</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3893488" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3893488</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng196er13.ref11">Campbell
|
|
TJ, Morgan
|
|
JJ. Treatment of atrial arrhythmias after cardiac surgery with intravenous disopyramide. Australian and New Zealand Journal of Medicine. 1980; 10(6):644–649 [<a href="https://pubmed.ncbi.nlm.nih.gov/6938185" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6938185</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng196er13.ref12">Chen
|
|
K, Qin
|
|
L, Lu
|
|
X, Xia
|
|
T, Gu
|
|
Q. Amiodarone in the treatment of atrial fibrillation of patients with rheumatic heart disease after valve replacement. Pakistan Journal of Medical Sciences. 2019; 35(4):918–922 [<a href="/pmc/articles/PMC6659075/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6659075</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31372117" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31372117</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng196er13.ref13">Chen
|
|
WS, Gao
|
|
BR, Chen
|
|
WQ, Li
|
|
ZZ, Xu
|
|
ZY, Zhang
|
|
YH
|
|
et al. Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: a prospective randomized trial. Journal of International Medical Research. 2013; 41(4):1067–1073 [<a href="https://pubmed.ncbi.nlm.nih.gov/23794519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23794519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng196er13.ref14">Cheng
|
|
JW. Vernakalant in the management of atrial fibrillation. Annals of Pharmacotherapy. 2008; 42(4):533–542 [<a href="https://pubmed.ncbi.nlm.nih.gov/18334607" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18334607</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng196er13.ref15">Cochrane
|
|
AD, Siddins
|
|
M, Rosenfeldt
|
|
FL, Salamonsen
|
|
R, McConaghy
|
|
L, Marasco
|
|
S
|
|
et al. A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 1994; 8(4):194–198 [<a href="https://pubmed.ncbi.nlm.nih.gov/8031562" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8031562</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng196er13.ref16">Connolly
|
|
SJ, Mulji
|
|
AS, Hoffert
|
|
DL, Davis
|
|
C, Shragge
|
|
BW. Randomized placebo-controlled trial of propafenone for treatment of atrial tachyarrhythmias after cardiac surgery. Journal of the American College of Cardiology. 1987; 10(5):1145–1148 [<a href="https://pubmed.ncbi.nlm.nih.gov/3499456" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3499456</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng196er13.ref17">Conte
|
|
SM, Florisson
|
|
DS, De Bono
|
|
JA, Davies
|
|
RA, Newcomb
|
|
AE. Management of atrial fibrillation after cardiac surgery. Internal Medicine Journal. 2019; 49(5):656–658 [<a href="https://pubmed.ncbi.nlm.nih.gov/31083803" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31083803</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng196er13.ref18">Crystal
|
|
E, Kahn
|
|
S, Roberts
|
|
R, Thorpe
|
|
K, Gent
|
|
M, Cairns
|
|
JA
|
|
et al. Long-term amiodarone therapy and the risk of complications after cardiac surgery: results from the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT). Journal of Thoracic and Cardiovascular Surgery. 2003; 125(3):633–637 [<a href="https://pubmed.ncbi.nlm.nih.gov/12658206" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12658206</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng196er13.ref19">Dagres
|
|
N, Iliodromitis
|
|
EK, Lekakis
|
|
JP, Simitsis
|
|
P, Karatzas
|
|
D, Rallidis
|
|
LS
|
|
et al. Ranolazine for the prevention or treatment of atrial fibrillation: a systematic review. Journal of Cardiovascular Medicine. 2014; 15(3):254–259 [<a href="https://pubmed.ncbi.nlm.nih.gov/24662415" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24662415</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng196er13.ref20">Daoud
|
|
EG. Management of atrial fibrillation in the post-cardiac surgery setting. Cardiology Clinics. 2004; 22(1):159–166 [<a href="https://pubmed.ncbi.nlm.nih.gov/14994855" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14994855</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng196er13.ref21">De Vecchis
|
|
R, Ariano
|
|
C, Giasi
|
|
A, Cioppa
|
|
C. Antiarrhythmic effects of ranolazine used both alone for prevention of atrial fibrillation and as an add-on to intravenous amiodarone for its pharmacological cardioversion: a meta-analysis. Minerva Cardioangiologica. 2018; 66(3):349–359 [<a href="https://pubmed.ncbi.nlm.nih.gov/28497941" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28497941</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng196er13.ref22">Department of Health. NHS reference costs 2017–18. 2018. Available from: <a href="https://improvement.nhs.uk/resources/reference-costs/#rc1718" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://improvement<wbr style="display:inline-block"></wbr>​.nhs<wbr style="display:inline-block"></wbr>​.uk/resources/reference-costs/#rc1718</a> Last accessed: 21/01/20.</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng196er13.ref23">deSouza
|
|
IS, Tadrous
|
|
M, Sexton
|
|
T, Benabbas
|
|
R, Carmelli
|
|
G, Sinert
|
|
R. Pharmacologic cardioversion of recent-onset atrial fibrillation and flutter in the emergency department: a systematic review and network meta-analysis. Annals of Emergency Medicine. 2020; 76(1):14–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/32173135" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32173135</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng196er13.ref24">deSouza
|
|
IS, Tadrous
|
|
M, Sexton
|
|
T, Benabbas
|
|
R, Carmelli
|
|
G, Sinert
|
|
R. Pharmacologic cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology. 2020; 22(6):854–869 [<a href="https://pubmed.ncbi.nlm.nih.gov/32176779" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32176779</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng196er13.ref25">Di Biasi
|
|
P, Scrofani
|
|
R, Paje
|
|
A, Cappiello
|
|
E, Mangini
|
|
A, Santoli
|
|
C. Intravenous amiodarone vs propafenone for atrial fibrillation and flutter after cardiac operation. European Journal of Cardio-Thoracic Surgery. 1995; 9(10):587–591 [<a href="https://pubmed.ncbi.nlm.nih.gov/8562105" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8562105</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng196er13.ref26">Ding
|
|
P, Li
|
|
L, Zhang
|
|
H, Chen
|
|
LJ, Deng
|
|
XJ, Yuan
|
|
YQ. Comparison of amiodarone plus irbesartan regimen versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation post valve replacement and cardioversion. Chinese Journal of Cardiovascular Diseases. 2009; 37(6):505–508 [<a href="https://pubmed.ncbi.nlm.nih.gov/19927630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19927630</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng196er13.ref27">Duggan
|
|
ST, Scott
|
|
LJ. Intravenous vernakalant: a review of its use in the management of recent-onset atrial fibrillation. Drugs. 2011; 71(2):237–252 [<a href="https://pubmed.ncbi.nlm.nih.gov/21275448" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21275448</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng196er13.ref28">Dunning
|
|
J, Khasati
|
|
N, Prendergast
|
|
B. What is the optimal medical treatment for stable cardiac surgical patients who go into atrial fibrillation after their operation?
|
|
Interactive Cardiovascular and Thoracic Surgery. 2004; 3(1):46–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/17670174" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17670174</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng196er13.ref29">Effert
|
|
S, Merx
|
|
W. On the treatment of atrial fibrillation following surgery of mitral stenosis. Deutsche Medizinische Wochenschrift. 1967; 92(15):691–695 [<a href="https://pubmed.ncbi.nlm.nih.gov/6023746" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6023746</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng196er13.ref30">Fellahi
|
|
JL, Heringlake
|
|
M, Knotzer
|
|
J, Fornier
|
|
W, Cazenave
|
|
L, Guarracino
|
|
F. Landiolol for managing atrial fibrillation in post-cardiac surgery. European Heart Journal Supplements. 2018; 20(Suppl A):A4–A9 [<a href="/pmc/articles/PMC5909770/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5909770</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30188961" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30188961</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng196er13.ref31">Fitzgerald
|
|
RD, Fritsch
|
|
S, Wislocki
|
|
W, Oczenski
|
|
W, Waldenberger
|
|
FR, Schwarz
|
|
S. Transvenous, intracardial cardioversion for the treatment of postoperative atrial fibrillation. Annals of Cardiac Anaesthesia. 2008; 11(2):111–115 [<a href="https://pubmed.ncbi.nlm.nih.gov/18603751" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18603751</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng196er13.ref32">Frost
|
|
L, Mortensen
|
|
PE, Tingleff
|
|
J, Platou
|
|
ES, Christiansen
|
|
EH, Christiansen
|
|
N. Efficacy and safety of dofetilide, a new class III antiarrhythmic agent, in acute termination of atrial fibrillation or flutter after coronary artery bypass surgery. International Journal of Cardiology. 1997; 58(2):135–140 [<a href="https://pubmed.ncbi.nlm.nih.gov/9049678" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9049678</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng196er13.ref33">Gao
|
|
L, Moodie
|
|
M. Modelling the lifetime cost-effectiveness of catheter ablation for atrial fibrillation with heart failure. BMJ Open. 2019; 9(9):e031033 [<a href="/pmc/articles/PMC6731807/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6731807</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31492790" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31492790</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng196er13.ref34">Gavaghan
|
|
TP, Koegh
|
|
AM, Kelly
|
|
RP, Campbell
|
|
TJ, Thorburn
|
|
C, Morgan
|
|
JJ. Flecainide compared with a combination of digoxin and disopyramide for acute atrial arrhythmias after cardiopulmonary bypass. British Heart Journal. 1988; 60(6):497–501 [<a href="/pmc/articles/PMC1224890/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1224890</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3146989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3146989</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng196er13.ref35">Gillinov
|
|
AM, Bagiella
|
|
E, Moskowitz
|
|
AJ, Raiten
|
|
JM, Groh
|
|
MA, Bowdish
|
|
ME
|
|
et al. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. New England Journal of Medicine. 2016; 374(20):1911–1921 [<a href="/pmc/articles/PMC4908812/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4908812</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27043047" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27043047</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng196er13.ref36">Gong
|
|
M, Zhang
|
|
Z, Fragakis
|
|
N, Korantzopoulos
|
|
P, Letsas
|
|
KP, Li
|
|
G
|
|
et al. Role of ranolazine in the prevention and treatment of atrial fibrillation: A meta-analysis of randomized clinical trials. Heart Rhythm. 2017; 14(1):3–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/27746384" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27746384</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng196er13.ref37">Gray
|
|
RJ, Conklin
|
|
CM, Sethna
|
|
DH, Mandel
|
|
WJ, Matloff
|
|
JM. Role of intravenous verapamil in supraventricular tachyarrhythmias after open-heart surgery. American Heart Journal. 1982; 104(4 Pt 1):799–802 [<a href="https://pubmed.ncbi.nlm.nih.gov/7124593" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7124593</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng196er13.ref38">Greenberg
|
|
JW, Lancaster
|
|
TS, Schuessler
|
|
RB, Melby
|
|
SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. European Journal of Cardio-Thoracic Surgery. 2017; 52(4):665–672 [<a href="https://pubmed.ncbi.nlm.nih.gov/28369234" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28369234</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng196er13.ref39">Gudbjartsson
|
|
T, Helgadottir
|
|
S, Sigurdsson
|
|
MI, Taha
|
|
A, Jeppsson
|
|
A, Christensen
|
|
TD
|
|
et al. New-onset postoperative atrial fibrillation after heart surgery. Acta Anaesthesiologica Scandinavica. 2019; [<a href="https://pubmed.ncbi.nlm.nih.gov/31724159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31724159</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng196er13.ref40">Guerra
|
|
F, Romandini
|
|
A, Barbarossa
|
|
A, Belardinelli
|
|
L, Capucci
|
|
A. Ranolazine for rhythm control in atrial fibrillation: a systematic review and meta-analysis. International Journal of Cardiology. 2017; 227:284–291 [<a href="https://pubmed.ncbi.nlm.nih.gov/27839812" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27839812</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng196er13.ref41">Gun
|
|
C, Bianco
|
|
ACM, Freire
|
|
RB, Ramos
|
|
RF, Timernan
|
|
A, Piegas
|
|
LS. CD-ROM of abstracts from World Cardiology Congress: 1998. Beta-blocker effects on postoperative atrial fibrillation after coronary artery bypass surgery. Journal of American College of Cardiology
|
|
1998, Issue 3801.</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng196er13.ref42">Ha
|
|
AC, Mazer
|
|
CD, Verma
|
|
S, Yanagawa
|
|
B, Verma
|
|
A. Management of postoperative atrial fibrillation after cardiac surgery. Current Opinion in Cardiology. 2016; 31(2):183–190 [<a href="https://pubmed.ncbi.nlm.nih.gov/26836987" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26836987</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng196er13.ref43">Habibollahi
|
|
P, Jam
|
|
SH, Vahdati
|
|
SS, Baghi
|
|
HM, Amiri
|
|
H. Amiodaron in atrial fibrillation: post coronary artery bypass graft. World Journal of Emergency Medicine. 2016; 7(4):250–254 [<a href="/pmc/articles/PMC5143307/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5143307</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27942340" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27942340</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng196er13.ref44">Han
|
|
QQ, Lang
|
|
XL, Han
|
|
L, Lu
|
|
FL, Zou
|
|
LJ, Xu
|
|
ZY. Ibutilide and amiodarone in management of new-onset atrial fibrillation after coronary artery bypass grafting: a comparison of safety and efficacy. Academic Journal of Second Military Medical University. 2010; 31(11):1169–1173</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng196er13.ref45">Helber
|
|
U, Steinhilber
|
|
B, Fenchel
|
|
G, Hoffmeister
|
|
HM. New occurance of post-operative atrial fibrillation after cardio-surgical operations: medical cardioversion verses placebo. Zeitschrift für Kardiologie. 1996; 85(Suppl 2):230</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng196er13.ref46">Hilleman
|
|
DE, Hunter
|
|
CB, Mohiuddin
|
|
SM, Maciejewski
|
|
S. Pharmacological management of atrial fibrillation following cardiac surgery. American Journal of Cardiovascular Drugs. 2005; 5(6):361–369 [<a href="https://pubmed.ncbi.nlm.nih.gov/16259524" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16259524</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng196er13.ref47">Hilleman
|
|
DE, Spinler
|
|
SA. Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials. Pharmacotherapy. 2002; 22(1):66–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/11794432" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11794432</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng196er13.ref48">Hjelms
|
|
E. Procainamide conversion of acute atrial fibrillation after open-heart surgery compared with digoxin treatment. Scandinavian Journal of Thoracic and Cardiovascular Surgery. 1992; 26(3):193–196 [<a href="https://pubmed.ncbi.nlm.nih.gov/1287833" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1287833</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng196er13.ref49">Hogue
|
|
Jr
|
|
CW, Hyder
|
|
ML. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Annals of Thoracic Surgery. 2000; 69(1):300–306 [<a href="https://pubmed.ncbi.nlm.nih.gov/10654548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10654548</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng196er13.ref50">Humphries
|
|
JO. Unexpected instant death following successful coronary artery bypass graft surgery (and other clinical settings): atrial fibrillation, quinidine, procainamide, et cetera, and instant death. Clinical Cardiology. 1998; 21(10):711–718 [<a href="/pmc/articles/PMC6656189/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6656189</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9789690" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9789690</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng196er13.ref51">Hwang
|
|
MH, Danoviz
|
|
J, Pacold
|
|
I, Rad
|
|
N, Loeb
|
|
HS, Gunnar
|
|
RM. Double-blind crossover randomized trial of intravenously administered verapamil. Its use for atrial fibrillation and flutter following open heart surgery. Archives of Internal Medicine. 1984; 144(3):491–494 [<a href="https://pubmed.ncbi.nlm.nih.gov/6703818" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6703818</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng196er13.ref52">Iliuta
|
|
L, Rac-Albu
|
|
M. Ivabradine versus beta-blockers in patients with conduction abnormalities or left ventricular dysfunction undergoing cardiac surgery. Cardiology and Therapy. 2013; 3(1–2):13–26 [<a href="/pmc/articles/PMC4265234/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4265234</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25135587" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25135587</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng196er13.ref53">Iscan
|
|
S, Eygi
|
|
B, Besir
|
|
Y, Yurekli
|
|
I, Cakir
|
|
H, Yilik
|
|
L
|
|
et al. Inflammation, atrial fibrillation and cardiac surgery: current medical and invasive approaches for the treatment of atrial fibrillation. Current Pharmaceutical Design. 2018; 24(3):310–322 [<a href="https://pubmed.ncbi.nlm.nih.gov/29384058" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29384058</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng196er13.ref54">Jannati
|
|
M. Atrial fibrillation post coronary artery graft surgery: a review of literature. International Journal of General Medicine. 2019; 12:415–420 [<a href="/pmc/articles/PMC6844194/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6844194</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31807054" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31807054</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng196er13.ref55">Ji
|
|
Q, Mei
|
|
Y, Wang
|
|
X, Feng
|
|
J, Wusha
|
|
D, Cai
|
|
J
|
|
et al. Combination of irbesartan and amiodarone to maintain sinus rhythm in patients with persistent atrial fibrillation after rheumatic valve replacement. Circulation Journal. 2010; 74(9):1873–1879 [<a href="https://pubmed.ncbi.nlm.nih.gov/20668354" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20668354</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng196er13.ref56">Jie
|
|
S, Yu
|
|
C, Xiaohu
|
|
L, Yanning
|
|
Q, Zhengnian
|
|
D, Xiaoyang
|
|
T. The effect of amiodarone on cardiac rhythm after cardiopulmonary bypass in patients with atrial fibrillation. Journal of Heart Valve Disease. 2010; 19(6):786–788 [<a href="https://pubmed.ncbi.nlm.nih.gov/21214105" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21214105</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng196er13.ref57">Johnston
|
|
BW, Hill
|
|
R, Duarte
|
|
R, Chean
|
|
CS, McAuley
|
|
DF, Blackwood
|
|
B
|
|
et al. Protocol for a systematic review and network meta-analysis of the management of new onset atrial fibrillation in critically unwell adult patients. Systematic Reviews. 2019; 8(1):242 [<a href="/pmc/articles/PMC6816145/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6816145</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31661022" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31661022</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng196er13.ref58">Jung
|
|
W, Meyerfeldt
|
|
U, Birkemeyer
|
|
R. Atrial arrhythmias after cardiac surgery in patients with diabetes mellitus. Clinical Research in Cardiology. 2006; 95 (Suppl 1):i88–i97 [<a href="https://pubmed.ncbi.nlm.nih.gov/16598557" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16598557</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng196er13.ref59">Kamali
|
|
A, Sanatkar
|
|
A, Sharifi
|
|
M, Moshir
|
|
E. Evaluation of amiodarone versus metoprolol in treating atrial fibrillation after coronary artery bypass grafting. Interventional Medicine and Applied Science. 2017; 9(2):51–55 [<a href="/pmc/articles/PMC5598126/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5598126</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28932497" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28932497</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng196er13.ref60">Kleine
|
|
P, Dzemali
|
|
O, Moritz
|
|
A. Internal cardioversion for treatment of postoperative atrial fibrillation. Surgical Technology International. 2003; 11:197–201 [<a href="https://pubmed.ncbi.nlm.nih.gov/12931301" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12931301</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="niceng196er13.ref61">Kolokotroni
|
|
SM, Toufektzian
|
|
L, Harling
|
|
L, Bille
|
|
A. In patients undergoing lung resection is it safe to administer amiodarone either as prophylaxis or treatment of atrial fibrillation?
|
|
Interactive Cardiovascular and Thoracic Surgery. 2017; 24(5):783–788 [<a href="https://pubmed.ncbi.nlm.nih.gov/28453809" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28453809</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng196er13.ref62">Koplan
|
|
BA. Adrenergic blockade for management of atrial fibrillation after coronary artery bypass surgery: Is it important to go beyond the beta1-receptor?
|
|
Heart Rhythm. 2007; 4(9):1175–1176 [<a href="https://pubmed.ncbi.nlm.nih.gov/17765617" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17765617</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng196er13.ref63">Kowey
|
|
PR. Ibutilide for AF termination after cardiac surgery. American Heart Journal. 1997; 134(1):139</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng196er13.ref64">Kowey
|
|
PR, Dorian
|
|
P, Mitchell
|
|
LB, Pratt
|
|
CM, Roy
|
|
D, Schwartz
|
|
PJ
|
|
et al. Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery: a randomized, double-blind, placebo-controlled trial. Circulation: Arrhythmia and Electrophysiology. 2009; 2(6):652–659 [<a href="https://pubmed.ncbi.nlm.nih.gov/19948506" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19948506</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng196er13.ref65">Landymore
|
|
RW, Howell
|
|
F. Recurrent atrial arrhythmias following treatment for postoperative atrial fibrillation after coronary bypass operations. European Journal of Cardio-Thoracic Surgery. 1991; 5(8):436–439 [<a href="https://pubmed.ncbi.nlm.nih.gov/1910852" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1910852</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng196er13.ref66">Larbuisson
|
|
R, Venneman
|
|
I, Stiels
|
|
B. The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 1996; 10(2):229–234 [<a href="https://pubmed.ncbi.nlm.nih.gov/8850403" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8850403</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng196er13.ref67">Lee
|
|
JK, Klein
|
|
GJ, Krahn
|
|
AD, Yee
|
|
R, Zarnke
|
|
K, Simpson
|
|
C
|
|
et al. Rate-control versus conversion strategy in postoperative atrial fibrillation: trial design and pilot study results. Cardiac Electrophysiology Review. 2003; 7(2):178–184 [<a href="https://pubmed.ncbi.nlm.nih.gov/14618047" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14618047</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng196er13.ref68">Lee
|
|
JK, Klein
|
|
GJ, Krahn
|
|
AD, Yee
|
|
R, Zarnke
|
|
K, Simpson
|
|
C
|
|
et al. Rate-control versus conversion strategy in postoperative atrial fibrillation: a prospective, randomized pilot study. American Heart Journal. 2000; 140(6):871–877 [<a href="https://pubmed.ncbi.nlm.nih.gov/11099990" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11099990</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng196er13.ref69">Liu
|
|
TJ, Hsueh
|
|
CW, Lee
|
|
WL, Lai
|
|
HC, Wang
|
|
KY, Ting
|
|
CT. Conversion of rheumatic atrial fibrillation by amiodarone after percutaneous balloon mitral commissurotomy. American Journal of Cardiology. 2003; 92(10):1244–1246 [<a href="https://pubmed.ncbi.nlm.nih.gov/14609612" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14609612</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="niceng196er13.ref70">Ma
|
|
W, Guo
|
|
X, Wang
|
|
Q, Sun
|
|
G, Wang
|
|
J. Systematic review and meta-analysis appraising efficacy and safety of vernakalant for cardioversion of recent-onset atrial fibrillation. Journal of Cardiovascular Pharmacology. 2020; 76(1):32–41 [<a href="https://pubmed.ncbi.nlm.nih.gov/32251022" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32251022</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="niceng196er13.ref71">Mahrose
|
|
R, Elsayed
|
|
AM, Elshorbagy
|
|
MS. Bisoprolol versus corticosteroid and bisoprolol combination for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery. Open Anesthesiology Journal. 2019; 13(1):18–24</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="niceng196er13.ref72">Maisel
|
|
WH, Rawn
|
|
JD, Stevenson
|
|
WG. Atrial fibrillation after cardiac surgery. Annals of Internal Medicine. 2001; 135(12):1061–1073 [<a href="https://pubmed.ncbi.nlm.nih.gov/11747385" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11747385</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng196er13.ref73">Mangin
|
|
L, Vinet
|
|
A, Page
|
|
P, Glass
|
|
L. Effects of antiarrhythmic drug therapy on atrioventricular nodal function during atrial fibrillation in humans. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology. 2005; 7:(Suppl 2):S71–S82 [<a href="https://pubmed.ncbi.nlm.nih.gov/16102505" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16102505</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="niceng196er13.ref74">Mann
|
|
CJ, Kendall
|
|
S, Lip
|
|
GYH. Acute management of atrial fibrillation with acute haemodynamic instability and in the postoperative setting. Heart. 2007; 93(1):45–47 [<a href="/pmc/articles/PMC1861334/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1861334</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16952970" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16952970</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng196er13.ref75">Martinez
|
|
EA, Bass
|
|
EB, Zimetbaum
|
|
P, American College of Chest P. Pharmacologic control of rhythm: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128(Suppl 2):48S–55S [<a href="https://pubmed.ncbi.nlm.nih.gov/16167665" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16167665</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng196er13.ref76">Martinez
|
|
EA, Epstein
|
|
AE, Bass
|
|
EB, American College of Chest P. Pharmacologic control of ventricular rate: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128(Suppl 2):56S–60S [<a href="https://pubmed.ncbi.nlm.nih.gov/16167666" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16167666</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="niceng196er13.ref77">McAlister
|
|
HF, Luke
|
|
RA, Smith
|
|
WM. Amiodarone versus quinidine reversion of atrial fibrillation post-cardiac surgery. Australian and New Zealand Journal of Medicine. 1986; 16:588</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng196er13.ref78">McAlister
|
|
HF, Luke
|
|
RA, Whitlock
|
|
RM, Smith
|
|
WM. Intravenous amiodarone bolus versus oral quinidine for atrial flutter and fibrillation after cardiac operations. The Journal of thoracic and cardiovascular surgery. 1990; 99(5):911–918 [<a href="https://pubmed.ncbi.nlm.nih.gov/2184287" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2184287</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng196er13.ref79">McKeown
|
|
PP, American College of Chest P. Introduction: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128(Suppl 2):6S–8S [<a href="https://pubmed.ncbi.nlm.nih.gov/16167658" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16167658</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng196er13.ref80">McMurry
|
|
SA, Hogue
|
|
Jr
|
|
CW. Atrial fibrillation and cardiac surgery. Current Opinion in Anaesthesiology. 2004; 17(1):63–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/17021530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17021530</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng196er13.ref81">Mooss
|
|
AN, Wurdeman
|
|
RL, Mohiuddin
|
|
SM, Reyes
|
|
AP, Sugimoto
|
|
JT, Scott
|
|
W
|
|
et al. Esmolol versus diltiazem in the treatment of postoperative atrial fibrillation/atrial flutter after open heart surgery. American Heart Journal. 2000; 140(1):176–180 [<a href="https://pubmed.ncbi.nlm.nih.gov/10874282" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10874282</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng196er13.ref82">Morttada
|
|
A, Ramzy
|
|
A, Ayoub
|
|
A, Khaled
|
|
S, Samir
|
|
S, Zaki
|
|
H. Effects of atrial fibrillation cardioversion after percutaneous mitral balloon valvuloplasty on echocardiographic left and right atrial functions. Journal of Atrial Fibrillation. 2016; 8(6):48–50 [<a href="/pmc/articles/PMC5089465/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5089465</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27909490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27909490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng196er13.ref83">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [Updated October 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/process/pmg20/chapter<wbr style="display:inline-block"></wbr>​/introduction-and-overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng196er13.ref84">Nemati
|
|
MH, Astaneh
|
|
B. Amiodarone versus propafenone to treat atrial fibrillation after coronary artery bypass grafting: a randomized double blind controlled trial. The Korean Journal of Thoracic and Cardiovascular Surgery. 2016; 49(3):177–184 [<a href="/pmc/articles/PMC4900860/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4900860</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27298795" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27298795</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng196er13.ref85">O’Bryan
|
|
LJ, Redfern
|
|
OC, Bedford
|
|
J, Petrinic
|
|
T, Young
|
|
JD, Watkinson
|
|
PJ. Managing new-onset atrial fibrillation in critically ill patients: a systematic narrative review. BMJ Open. 2020; 10(3):e034774 [<a href="/pmc/articles/PMC7202704/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7202704</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32209631" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32209631</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng196er13.ref86">Ozaydin
|
|
M, Erdogan
|
|
D, Yucel
|
|
H, Peker
|
|
O, Icli
|
|
A, Akcay
|
|
S
|
|
et al. N-acetyl cysteine for the conversion of atrial fibrillation into sinus rhythm after cardiac surgery: a prospective, randomized, double-blind, placebo-controlled pilot study. International Journal of Cardiology. 2013; 165(3):580–583 [<a href="https://pubmed.ncbi.nlm.nih.gov/23041016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23041016</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="niceng196er13.ref87">Patel
|
|
D, Gillinov
|
|
MA, Natale
|
|
A. Atrial fibrillation after cardiac surgery: where are we now?
|
|
Indian Pacing and Electrophysiology Journal. 2008; 8(4):281–291 [<a href="/pmc/articles/PMC2572025/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2572025</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18982137" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18982137</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="niceng196er13.ref88">Plumb
|
|
VJ, Karp
|
|
RB, Kouchoukos
|
|
NT, Zorn
|
|
GL, Jr., James
|
|
TN, Waldo
|
|
AL. Verapamil therapy of atrial fibrillation and atrial flutter following cardiac operation. The Journal of thoracic and cardiovascular surgery. 1982; 83(4):590–596 [<a href="https://pubmed.ncbi.nlm.nih.gov/7038316" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7038316</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng196er13.ref89">Qian
|
|
YJ, Xiao
|
|
XJ, Yuan
|
|
HS, Tang
|
|
H, Shao
|
|
HZ, Wei
|
|
DM. Combination pharmacological cardioversion of permanent atrial fibrillation in post-prosthetic mitral valve replacement outpatients: a novel approach for the treatment of atrial fibrillation. Journal of International Medical Research. 2008; 36(3):537–543 [<a href="https://pubmed.ncbi.nlm.nih.gov/18534136" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18534136</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="niceng196er13.ref90">Rho
|
|
RW, Bridges
|
|
CR, Kocovic
|
|
D. Management of postoperative arrhythmias. Seminars in Thoracic and Cardiovascular Surgery. 2000; 12(4):349–361 [<a href="https://pubmed.ncbi.nlm.nih.gov/11154730" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11154730</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="niceng196er13.ref91">Rosenberg
|
|
K. Rate and rhythm control are equally effective in treating postoperative atrial fibrillation. American Journal of Nursing. 2016; 116(8):53–54 [<a href="https://pubmed.ncbi.nlm.nih.gov/27466928" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27466928</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="niceng196er13.ref92">Sai
|
|
C, Li
|
|
J, Ruiyan
|
|
M, Yingbin
|
|
X. Atorvastatin prevents postoperative atrial fibrillation in patients undergoing cardiac surgery. Hellenic Journal of Cardiology. 2019; 60(1):40–47 [<a href="https://pubmed.ncbi.nlm.nih.gov/29307691" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29307691</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="niceng196er13.ref93">Sakamoto
|
|
A, Kitakaze
|
|
M, Takamoto
|
|
S, Namiki
|
|
A, Kasanuki
|
|
H, Hosoda
|
|
S
|
|
et al. Landiolol, an ultra-short-acting beta1-blocker, more effectively terminates atrial fibrillation than diltiazem after open heart surgery: prospective, multicenter, randomized, open-label study (JL-KNIGHT study). Circulation Journal. 2012; 76(5):1097–1101 [<a href="https://pubmed.ncbi.nlm.nih.gov/22361918" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22361918</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="niceng196er13.ref94">Savelieva
|
|
I, Graydon
|
|
R, Camm
|
|
AJ. Pharmacological cardioversion of atrial fibrillation with vernakalant: evidence in support of the ESC Guidelines. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology. 2014; 16(2):162–173 [<a href="https://pubmed.ncbi.nlm.nih.gov/24108230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24108230</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>95.</dt><dd><div class="bk_ref" id="niceng196er13.ref95">Schleifer
|
|
JW, Ramakrishna
|
|
H. Perioperative atrial fibrillation: a systematic review of evolving therapeutic options in pharmacologic and procedural management. Annals of Cardiac Anaesthesia. 2015; 18(4):565–570 [<a href="/pmc/articles/PMC4881665/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4881665</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26440243" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26440243</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="niceng196er13.ref96">Schwartz
|
|
M, Michelson
|
|
EL, Sawin
|
|
HS, MacVaugh
|
|
H, 3rd. Esmolol: safety and efficacy in postoperative cardiothoracic patients with supraventricular tachyarrhythmias. Chest. 1988; 93(4):705–711 [<a href="https://pubmed.ncbi.nlm.nih.gov/2894920" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2894920</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>97.</dt><dd><div class="bk_ref" id="niceng196er13.ref97">Selvaraj
|
|
T, Kiran
|
|
U, Das
|
|
S, Chauhan
|
|
S, Sahu
|
|
B, Gharde
|
|
P. Effect of single intraoperative dose of amiodarone in patients with rheumatic valvular heart disease and atrial fibrillation undergoing valve replacement surgery. Annals of Cardiac Anaesthesia. 2009; 12(1):10–16 [<a href="https://pubmed.ncbi.nlm.nih.gov/19136749" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19136749</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="niceng196er13.ref98">Shantsila
|
|
E, Watson
|
|
T, Lip
|
|
GYH. Atrial fibrillation post-cardiac surgery: changing perspectives. Current Medical Research and Opinion. 2006; 22(8):1437–1441 [<a href="https://pubmed.ncbi.nlm.nih.gov/16870069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16870069</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="niceng196er13.ref99">Shen
|
|
SL, Zhao
|
|
YC. A comparative study on the efficacy and safety of intravenous esmolol, amiodarone and diltiazem for controlling rapid ventricular rate of patients with atrial fibrillation during anesthesia period. Chinese Journal of Cardiovascular Diseases. 2010; 38(11):989–992 [<a href="https://pubmed.ncbi.nlm.nih.gov/21215227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21215227</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="niceng196er13.ref100">Simopoulos
|
|
V, Hevas
|
|
A, Hatziefthimiou
|
|
A, Dipla
|
|
K, Skoularigis
|
|
I, Tsilimingas
|
|
N
|
|
et al. Amiodarone plus ranolazine for conversion of post-cardiac surgery atrial fibrillation: enhanced effectiveness in reduced versus preserved ejection fraction patients. Cardiovascular Drugs and Therapy. 2018; 32(6):559–565 [<a href="https://pubmed.ncbi.nlm.nih.gov/30255400" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30255400</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>101.</dt><dd><div class="bk_ref" id="niceng196er13.ref101">Simopoulos
|
|
V, Tagarakis
|
|
GI, Daskalopoulou
|
|
SS, Daskalopoulos
|
|
ME, Lenos
|
|
A, Chryssagis
|
|
K
|
|
et al. Ranolazine enhances the antiarrhythmic activity of amiodarone by accelerating conversion of new-onset atrial fibrillation after cardiac surgery. Angiology. 2014; 65(4):294–297 [<a href="https://pubmed.ncbi.nlm.nih.gov/23427280" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23427280</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>102.</dt><dd><div class="bk_ref" id="niceng196er13.ref102">Somberg
|
|
J, Molnar
|
|
J. Sotalol versus amiodarone in treatment of atrial fibrillation. Journal of Atrial Fibrillation. 2016; 8(5):1359 [<a href="/pmc/articles/PMC5089490/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5089490</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27909477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27909477</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>103.</dt><dd><div class="bk_ref" id="niceng196er13.ref103">Soucier
|
|
R, Silverman
|
|
D, Abordo
|
|
M, Jaagosild
|
|
P, Abiose
|
|
A, Madhusoodanan
|
|
KP
|
|
et al. Propafenone versus ibutilide for post operative atrial fibrillation following cardiac surgery: neither strategy improves outcomes compared to rate control alone (the PIPAF study). Medical Science Monitor. 2003; 9(3):19–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/12640352" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12640352</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>104.</dt><dd><div class="bk_ref" id="niceng196er13.ref104">Stiell
|
|
IG, Sivilotti
|
|
MLA, Taljaard
|
|
M, Birnie
|
|
D, Vadeboncoeur
|
|
A, Hohl
|
|
CM
|
|
et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial. Lancet. 2020; 395(10221):339–349 [<a href="https://pubmed.ncbi.nlm.nih.gov/32007169" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32007169</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>105.</dt><dd><div class="bk_ref" id="niceng196er13.ref105">Szyszka
|
|
A, Wachowiak-Baszyńska
|
|
H, Paluszkiewicz
|
|
L, Skorupski
|
|
W, Brocki
|
|
Z. Preventive pharmacological treatment after cardiac electroversion for atrial fibrillation following surgical treatment of heart defects. Kardiologia Polska. 1992; 37(8):74–78 [<a href="https://pubmed.ncbi.nlm.nih.gov/1434328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1434328</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>106.</dt><dd><div class="bk_ref" id="niceng196er13.ref106">Taenaka
|
|
N, Kikawa
|
|
S. The effectiveness and safety of landiolol hydrochloride, an ultra-short-acting beta1-blocker, in postoperative patients with supraventricular tachyarrhythmias: a multicenter, randomized, double-blind, placebo-controlled study. American Journal of Cardiovascular Drugs. 2013; 13(5):353–364 [<a href="/pmc/articles/PMC3781301/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3781301</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23818039" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23818039</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>107.</dt><dd><div class="bk_ref" id="niceng196er13.ref107">Tisdale
|
|
JE, Padhi
|
|
ID, Goldberg
|
|
AD, Silverman
|
|
NA, Webb
|
|
CR, Higgins
|
|
RS
|
|
et al. A randomized, double-blind comparison of intravenous diltiazem and digoxin for atrial fibrillation after coronary artery bypass surgery. American Heart Journal. 1998; 135(5 Pt 1):739–747 [<a href="https://pubmed.ncbi.nlm.nih.gov/9588402" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9588402</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>108.</dt><dd><div class="bk_ref" id="niceng196er13.ref108">Tsu
|
|
LV, Lee
|
|
S. Use of ranolazine in the prevention and treatment of postoperative atrial fibrillation in patients undergoing cardiac surgery. Annals of Pharmacotherapy. 2014; 48(5):633–637 [<a href="https://pubmed.ncbi.nlm.nih.gov/24523397" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24523397</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>109.</dt><dd><div class="bk_ref" id="niceng196er13.ref109">VanderLugt
|
|
JT, Mattioni
|
|
T, Denker
|
|
S, Torchiana
|
|
D, Ahern
|
|
T, Wakefield
|
|
LK
|
|
et al. Efficacy and safety of ibutilide fumarate for the conversion of atrial arrhythmias after cardiac surgery. Circulation. 1999; 100(4):369–375 [<a href="https://pubmed.ncbi.nlm.nih.gov/10421596" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10421596</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>110.</dt><dd><div class="bk_ref" id="niceng196er13.ref110">Vilvanathan
|
|
VK, Srinivas Prabhavathi Bhat
|
|
BC, Nanjappa
|
|
MC, Pandian
|
|
B, Bagi
|
|
V, Kasturi
|
|
S
|
|
et al. A randomized placebo-controlled trial with amiodarone for persistent atrial fibrillation in rheumatic mitral stenosis after successful balloon mitral valvuloplasty. Indian Heart Journal. 2016; 68(5):671–677 [<a href="/pmc/articles/PMC5079138/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5079138</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27773406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27773406</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>111.</dt><dd><div class="bk_ref" id="niceng196er13.ref111">Wafa
|
|
SS, Ward
|
|
DE, Parker
|
|
DJ, Camm
|
|
AJ. Efficacy of flecainide acetate for atrial arrhythmias following coronary artery bypass grafting. American Journal of Cardiology. 1989; 63(15):1058–1064 [<a href="https://pubmed.ncbi.nlm.nih.gov/2495710" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2495710</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>112.</dt><dd><div class="bk_ref" id="niceng196er13.ref112">White
|
|
CM, Nguyen
|
|
E. Novel use of ranolazine as an antiarrhythmic agent in atrial fibrillation. Annals of Pharmacotherapy. 2017; 51(3):245–252 [<a href="https://pubmed.ncbi.nlm.nih.gov/27758968" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27758968</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>113.</dt><dd><div class="bk_ref" id="niceng196er13.ref113">Yilmaz
|
|
AT, Demirkilic
|
|
U, Arslan
|
|
M, Kurulay
|
|
E, Ozal
|
|
E, Tatar
|
|
H
|
|
et al. Long-term prevention of atrial fibrillation after coronary artery bypass surgery: comparison of quinidine, verapamil, and amiodarone in maintaining sinus rhythm. Journal of Cardiac Surgery. 1996; 11(1):61–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/8775337" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8775337</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng196er13.appa"><h3>Appendix A. Review protocols</h3><p id="niceng196er13.appa.et1"><a href="/books/NBK571341/bin/niceng196er13-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 21. Review protocol: Treatment of atrial fibrillation after cardiothoracic surgery</a><span class="small"> (PDF, 279K)</span></p><p id="niceng196er13.appa.et2"><a href="/books/NBK571341/bin/niceng196er13-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 22. Health economic review protocol</a><span class="small"> (PDF, 165K)</span></p></div><div id="niceng196er13.appb"><h3>Appendix B. Literature search strategies</h3><p>This literature search strategy was used for the following reviews:
|
|
<ul><li class="half_rhythm"><div><b>What is the most clinical and cost-effective treatment strategy (rate or rhythm control or no treatment) for people with atrial fibrillation after cardiothoracic surgery?</b></div></li></ul></p><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er13.ref83" rid="niceng196er13.ref83"><sup>83</sup></a></p><p>For more information, please see the Methods Report published as part of the accompanying documents for this guideline.</p><p id="niceng196er13.appb.et1"><a href="/books/NBK571341/bin/niceng196er13-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 321K)</span></p><p id="niceng196er13.appb.et2"><a href="/books/NBK571341/bin/niceng196er13-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 239K)</span></p></div><div id="niceng196er13.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="niceng196er13.appc.et1"><a href="/books/NBK571341/bin/niceng196er13-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of treatment of atrial fibrillation after cardiothoracic surgery</a><span class="small"> (PDF, 45K)</span></p></div><div id="niceng196er13.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng196er13.appd.et1"><a href="/books/NBK571341/bin/niceng196er13-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (564K)</span></p></div><div id="niceng196er13.appe"><h3>Appendix E. Forest plots</h3><p id="niceng196er13.appe.et1"><a href="/books/NBK571341/bin/niceng196er13-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. Mixed/unclear stratum</a><span class="small"> (PDF, 43K)</span></p><p id="niceng196er13.appe.et2"><a href="/books/NBK571341/bin/niceng196er13-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. No pre-existing AF stratum</a><span class="small"> (PDF, 159K)</span></p><p id="niceng196er13.appe.et3"><a href="/books/NBK571341/bin/niceng196er13-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.3. Pre-existing AF stratum</a><span class="small"> (PDF, 53K)</span></p></div><div id="niceng196er13.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng196er13.appf.et1"><a href="/books/NBK571341/bin/niceng196er13-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 25. Clinical evidence profile: Mixed/unclear stratum – calcium channel blockers vs. placebo</a><span class="small"> (PDF, 421K)</span></p><p id="niceng196er13.appf.et2"><a href="/books/NBK571341/bin/niceng196er13-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 26. Clinical evidence profile: No pre-existing AF stratum – DC cardioversion vs. K+ blockers</a><span class="small"> (PDF, 118K)</span></p><p id="niceng196er13.appf.et3"><a href="/books/NBK571341/bin/niceng196er13-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 27. Clinical evidence profile: No pre-existing AF stratum – K+ blockers vs. digoxin</a><span class="small"> (PDF, 121K)</span></p><p id="niceng196er13.appf.et4"><a href="/books/NBK571341/bin/niceng196er13-appf-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 28. Clinical evidence profile: No pre-existing AF stratum – K+ blockers vs. K+ blockers + ranolazine</a><span class="small"> (PDF, 102K)</span></p><p id="niceng196er13.appf.et5"><a href="/books/NBK571341/bin/niceng196er13-appf-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 29. Clinical evidence profile: No pre-existing AF stratum – mixed rate control vs. K+ blockers with/without rate control agent</a><span class="small"> (PDF, 137K)</span></p><p id="niceng196er13.appf.et6"><a href="/books/NBK571341/bin/niceng196er13-appf-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 30. Clinical evidence profile: No pre-existing AF stratum – mixed rhythm control +/- electrical cardioversion vs. mixed rate control</a><span class="small"> (PDF, 116K)</span></p><p id="niceng196er13.appf.et7"><a href="/books/NBK571341/bin/niceng196er13-appf-et7.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 31. Clinical evidence profile: No pre-existing AF stratum – Na+ blockers vs. digoxin</a><span class="small"> (PDF, 120K)</span></p><p id="niceng196er13.appf.et8"><a href="/books/NBK571341/bin/niceng196er13-appf-et8.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 32. Clinical evidence profile: No pre-existing AF stratum – Na+ blockers vs. K+ blockers</a><span class="small"> (PDF, 97K)</span></p><p id="niceng196er13.appf.et9"><a href="/books/NBK571341/bin/niceng196er13-appf-et9.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 33. Clinical evidence profile: No pre-existing AF stratum – Calcium channel blockers vs. placebo</a><span class="small"> (PDF, 92K)</span></p><p id="niceng196er13.appf.et10"><a href="/books/NBK571341/bin/niceng196er13-appf-et10.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 34. Clinical evidence profile: No pre-existing AF stratum – K+ blockers (vernakalant)vs. placebo</a><span class="small"> (PDF, 122K)</span></p><p id="niceng196er13.appf.et11"><a href="/books/NBK571341/bin/niceng196er13-appf-et11.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 35. Clinical evidence profile: No pre-existing AF stratum – K+ blockers (amiodarone) vs. routine medical treatment alone</a><span class="small"> (PDF, 121K)</span></p><p id="niceng196er13.appf.et12"><a href="/books/NBK571341/bin/niceng196er13-appf-et12.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 36. Clinical evidence profile: Pre-existing AF stratum – DC cardioversion vs. K+ blockers + captopril + simvastatin</a><span class="small"> (PDF, 127K)</span></p><p id="niceng196er13.appf.et13"><a href="/books/NBK571341/bin/niceng196er13-appf-et13.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 37. Clinical evidence profile: Pre-existing AF stratum – Mixed rate control vs. K+ blockers + captopril + simvastatin</a><span class="small"> (PDF, 124K)</span></p><p id="niceng196er13.appf.et14"><a href="/books/NBK571341/bin/niceng196er13-appf-et14.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 38. Clinical evidence profile: Pre-existing AF stratum – K+ blockers + DC cardioversion vs. placebo + DC cardioversion</a><span class="small"> (PDF, 107K)</span></p></div><div id="niceng196er13.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="niceng196er13.appg.et1"><a href="/books/NBK571341/bin/niceng196er13-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 45. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 99K)</span></p></div><div id="niceng196er13.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None.</p></div><div id="niceng196er13.appi"><h3>Appendix I. Excluded studies</h3><p id="niceng196er13.appi.et1"><a href="/books/NBK571341/bin/niceng196er13-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">I.1. Excluded clinical studies</a><span class="small"> (PDF, 158K)</span></p><p id="niceng196er13.appi.et2"><a href="/books/NBK571341/bin/niceng196er13-appi-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">I.2. Excluded health economic studies</a><span class="small"> (PDF, 98K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review</p><p>Developed by the National Guideline Centre, Royal College of Physicians</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patientand, where appropriate,their carer or guardian.</p><p>Local commissioners andproviders have a responsibility to enable the guideline to be applied when individual health professionals and theirpatients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK571341</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34165940" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34165940</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng196er13tab1"><div id="niceng196er13.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng196er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng196er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 18 who have had cardiothoracic surgery and who have post-operative AF (stratified by pre-existing AF vs. no pre-existing AF)</td></tr><tr><th id="hd_b_niceng196er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng196er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Rate control strategies (lists below are not exhaustive):</b>
|
|
<ul><li class="half_rhythm"><div>Beta blockers -for example, bisoprolol, acebutolol, metoprolol, nadolol, pindolol, betaspace, propranolol, esmalol</div></li><li class="half_rhythm"><div>Ca2+ channel blockers – for example, diltiazem hydrochloride, verapamil</div></li><li class="half_rhythm"><div>Digoxin</div></li><li class="half_rhythm"><div>Amiodarone*</div></li></ul>
|
|
<b>Rhythm control strategies (lists below are not exhaustive):</b>
|
|
<ul><li class="half_rhythm"><div>Na+ channel blockers – such as procainamide, disopyramide, quinidine sulphate, flecainide, propafenone</div></li><li class="half_rhythm"><div>K+ channel blockers – such as amiodarone*, dronedarone, ibutilide, sotalol</div></li><li class="half_rhythm"><div>DC cardioversion</div></li></ul>
|
|
*amiodarone may be used for rate or rhythm control.</td></tr><tr><th id="hd_b_niceng196er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_niceng196er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Placebo</div></li><li class="half_rhythm"><div>No treatment</div></li><li class="half_rhythm"><div>To each other (between classes of intervention – i.e. beta blockers vs Ca channel blockers, or digoxin versus DC cardioversion).</div></li><li class="half_rhythm"><div>RCTs where individuals in the intervention group may be prescribed different rate or rhythm drugs are allowed.</div></li></ul>
|
|
No comparisons within classes will be included (i.e. bisoprolol versus pindolol, or procainamide versus flecainide)</td></tr><tr><th id="hd_b_niceng196er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng196er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>health-related quality of life</div></li><li class="half_rhythm"><div>mortality</div></li><li class="half_rhythm"><div>stroke or thromboembolic complications</div></li><li class="half_rhythm"><div>Need for rescue DC cardioversion</div></li><li class="half_rhythm"><div>Rehospitalisation (all cause)</div></li><li class="half_rhythm"><div>Rehospitalisation for AF</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul>
|
|
<b>Important</b>
|
|
<ul><li class="half_rhythm"><div>freedom from anticoagulation</div></li><li class="half_rhythm"><div>freedom from AAD use</div></li><li class="half_rhythm"><div>Hospital length of stay</div></li><li class="half_rhythm"><div>ICU length of stay</div></li></ul></td></tr><tr><th id="hd_b_niceng196er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng196er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trials and systematic reviews of RCTs</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab2"><div id="niceng196er13.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention and comparison</th><th id="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Chen 2013<a class="bibr" href="#niceng196er13.ref13" rid="niceng196er13.ref13"><sup>13</sup></a></p><p>RCT</p><p>N=115</p><p>Conducted in China</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>DC cardioversion:</b> Initial 200mg amiodarone three times daily for four days. Electrical defibrillation was performed on fifth day. Once unconscious, patients received direct-current synchronized electrical cardioversion using an initial energy level of 200 J. If the first shock failed, two 300 J shocks were given.</p><p>Electrical treatment was stopped if sinus rhythm was not restored within three shocks.</p><p>After reversion to normal rhythm, 200 mg amiodarone was taken daily for 30 days</p><p><b>K+ blockers + captopril + simvastatin:</b> Oral amiodarone with captoptri land simvastatin.</p><p>Three months combination therapy with oral amiodarone at a dose of 600 mg/day for 3 days, 400 mg/day for the following 3 days and then 200 mg/day, oral captopril at a dose of 12.5 mg twice daily before food and oral simvastatin at a dose of 15 mg/day at night.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Pre-existing AF stratum: those with pre-existing permanent AF prior to mitral valve replacement operation.</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Age >18 years with permanent AF</div></li><li class="half_rhythm"><div>Undergone prosthetic mitral valve replacement with or without aortic valve replacement</div></li><li class="half_rhythm"><div>Cardiothoracic ratio ≤0.5 on cardiac anterioposterior X-radiography and a left atrial diameter ≤50 mm on Doppler ultrasound for ≥6 months post-surgery</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>New York Heart Association heart failure class IV</div></li><li class="half_rhythm"><div>History of sick sinus syndrome or second-or third-degree atrioventricular block</div></li><li class="half_rhythm"><div>Severe hepatic and/or renal dysfunction</div></li><li class="half_rhythm"><div>Hyperthyroidism</div></li><li class="half_rhythm"><div>Contraindications to treatment with amiodarone</div></li></ul>
|
|
Population characteristics:
|
|
<ul><li class="half_rhythm"><div>Mean (SD) duration of AF: 54.2 (25.9) vs. 53.5 (25.4) months</div></li><li class="half_rhythm"><div>Mean (SD) LVEF: 58.6 (6.5) vs. 58.2 (6.2)%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Rehospitalisation for AF</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All patients received standard long-term anticoagulant therapy with warfarin and/or digoxin following surgery.</td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Chen 2019<a class="bibr" href="#niceng196er13.ref12" rid="niceng196er13.ref12"><sup>12</sup></a></p><p>RCT</p><p>N=84</p><p>Conducted in China</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers(amiodarone):</b>On the day of the operation, a micro infusion pump administered 600 mg amiodarone at 50 mg/h for 12 h. On postoperative day 1, amiodarone taken orally following recovery of diet 3 times daily. A week later, patients took amiodarone 2 times daily. Another week later, the dose was reduced to once daily. Treatment course was 1 month. Also received routine medical treatment as described in the control group.</p><p><b>Routine medical treatment:</b> Routine treatment consisted of oral administration of drugs for diuresis, anticoagulation and routine application of antibiotics.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: states AF developed following valve replacement</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Elective valvular replacement</div></li><li class="half_rhythm"><div>Rheumatic heart disease with continuous atrial fibrillation</div></li><li class="half_rhythm"><div>Cardiac function no higher than grade III</div></li><li class="half_rhythm"><div>Satisfied application indication for amiodarone</div></li><li class="half_rhythm"><div>Normal levels of electrolytes and acidity and alkalinity</div></li><li class="half_rhythm"><div>Heart rate <70 bpm</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Presence of other types of arrhythmia</div></li></ul>
|
|
Population characteristics:
|
|
<ul><li class="half_rhythm"><div>Mean (SD) duration of AF: 30 (14.93) vs. 31.06 (15.02) months</div></li><li class="half_rhythm"><div>Mean (SD) left ventricular ejection fraction: 46.7 (4.32) vs. 47.5 (4.03)%</div></li><li class="half_rhythm"><div>Mean (SD) New York Heart Association score: 2.50 (0.51) vs. 2.58 (0.50)</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Hospital length of stay</div></li><li class="half_rhythm"><div>ICU length of stay</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Cochrane 1994<a class="bibr" href="#niceng196er13.ref15" rid="niceng196er13.ref15"><sup>15</sup></a></p><p>RCT</p><p>N=30</p><p>Conducted in Australia</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers:</b> Intravenous amiodarone. Loading dose of 5 mg/kg (max. 400 mg) in 100 ml of 5% dextrose infused intravenously over 30 min.</p><p>At 30 min after loading dose complete, infusion of 25 mg/h initiated. Infusion increased to 40 mg/h if ventricular rate still exceeded 120 beats/min after 6 h. Treatment continued for 24 h after reversion to sinus rhythm.</p><p>If no reversion following 24 h of intravenous amiodarone infusion, digoxin was added at half the dose used in the digoxin treatment group</p><p><b>Digoxin:</b> Intravenous digoxin. Loading dose of 1 mg given intravenously over 9 h as follows: 0.5 mg over 30 min at start of treatment, followed by 0.25 mg after 2 h and 0.125 mg after 5 h and 9 h.</p><p>Oral maintenance therapy started within 12 h at a dose suitable for body weight and renal function.</p><p>If reversion did not occur during 24 h treatment period amiodarone was added at dose described for amiodarone group and digoxin continued at half the previous dose</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: AF prior to surgery was an exclusion criterion</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>People that developed AF persisting for >20 min with systolic blood pressure of ≥85 mmHg without inotropic support, while recovering from open heart surgery</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>AF prior to surgery</div></li><li class="half_rhythm"><div>Poor ventricular contractility on preoperative left venticulogram</div></li><li class="half_rhythm"><div>Postoperative administration of beta-blockers</div></li></ul>
|
|
Population characteristics:
|
|
<ul><li class="half_rhythm"><div>Operation type: coronary artery bypass grafting(73 vs. 67%), aortic valve replacement(20 vs. 20%), mitral valvotomy(7 vs. 0%)or combined procedures(0 vs. 13%)</div></li><li class="half_rhythm"><div>Pre-operative beta-blockade: 47 vs. 53%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Need for rescue DC cardioversion</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Fitzgerald 2008<a class="bibr" href="#niceng196er13.ref31" rid="niceng196er13.ref31"><sup>31</sup></a></p><p>RCT</p><p>N=18</p><p>Conducted in Austria</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>DC cardioversion</b></p><p>ALERT catheter for intracardiac conversion.</p><p>Sedation with midazolam (3–5 mg intravenously) and intracardiac cardioversion.</p><p>ALERT system provides temporary pacing, sensing and delivery of stimuli for internal cardioversion.</p><p>First shock with 3 J. Following each shock, 12-lead ECG was obtained to assess sinus rhythm. If rhythm was not converted, shock energy was increased by increments of 3 J to a maximum of 15 J.</p><p>If no response after 15 J shock, the patient was classified as being not responsive. When awake and haemodynamically stable patients were returned to the ward. Non-responders received treatment according to the preference of the doctor in charge and were excluded from further evaluation</p><p><b>K+ blockers</b></p><p>Standard pulmonary artery catheter for delivery of intravenous amiodarone. Bolus dose of 250 mg followed by continuous infusion of 0.6 mg/kg/h. Duration unclear.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: chronic AF and conduction disorders were exclusion criteria</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Undergoing coronary artery bypass grafting or valve surgery</div></li><li class="half_rhythm"><div>Postoperative AF development</div></li></ul></p><p>Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Chronic atrial fibrillation</div></li><li class="half_rhythm"><div>Conduction disorders</div></li><li class="half_rhythm"><div>Patients with pacemakers</div></li></ul></p><p>Population characteristics:
|
|
<ul><li class="half_rhythm"><div>Type of surgery: CABG (44 vs. 56%), aortic valve (22 vs. 22%), mitral valve (11 vs. 11%), CABG + valve (22 vs. 11%)</div></li><li class="half_rhythm"><div>NYHA class: I (11 vs. 11%), II (56 vs. 67%), III (22 vs. 11%), IV (11 vs. 11%)</div></li><li class="half_rhythm"><div>Median (range) ejection fraction: 53 (31–74) vs. 59 (36–68)%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Need for rescue DC cardioversion</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>In both groups:</b> Patients allowed treatment with intravenous digoxin if tachycardia led to haemodynamic instability at any time prior to the intervention. If this treatment was not successful in establishing stability and further treatment was required, patients were excluded from further evaluation</td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Gillinov 2016<a class="bibr" href="#niceng196er13.ref35" rid="niceng196er13.ref35"><sup>35</sup></a></p><p>RCT</p><p>N=523</p><p>Conducted in Canada and USA</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Mixed rate control</b></p><p>Received medications to slow heart rate with aim of achieving a resting heart rate <100 beats/min.</p><p>Patients in whom sinus rhythm was not restored after rate control could be switched to rhythm control if provider thought necessary to improve haemodynamic status or alleviate symptoms.</p><p>Duration 60 days. No further details on the interventions given.</p><p><b>K+ blocker with/without rate control agent</b></p><p>Amiodarone with or without rate-slowing agent.</p><p>If atrial fibrillation persisted for 24–48 h after randomisation, direct current cardioversion was recommended.</p><p>Recommended dose of amiodarone was 3 g of oral amiodarone before hospital discharge with a maintenance dose of 200 mg/day or less if direct current cardioversion was successful.</p><p>It was recommended that the use of amiodarone be extended for 60 days, but discontinuation was allowed for amiodarone-related adverse events, such as bradycardia, corrected QT interval >480 msec or neuropathy</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF: History of AF was an exclusion criterion</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Haemodynamically stable adults</div></li><li class="half_rhythm"><div>Undergone elective surgery to treat coronary artery disease or heart valve disease</div></li><li class="half_rhythm"><div>Postoperative atrial fibrillation persisting for >60 min or recurrent episodes of atrial fibrillation during index hospitalisation</div></li></ul></p><p>Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>History of atrial fibrillation</div></li></ul></p><p>Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>Diabetes: 31.3 vs. 30.3%</div></li><li class="half_rhythm"><div>Heart failure: 13.4 vs. 12.6%</div></li><li class="half_rhythm"><div>Hypertension: 73.7 vs. 75.9%</div></li><li class="half_rhythm"><div>Previous myocardial infarction: 19.1 vs. 18.4%</div></li><li class="half_rhythm"><div>Previous stroke: 6.5 vs. 5.7%</div></li><li class="half_rhythm"><div>Medication: ACE inhibitor (34 vs. 32.2%), ARB (19.5 vs. 18%), beta-blocker (61.8 vs. 55.6%), calcium channel blocker (19.8 vs. 22.2%), diuretic (30.2 vs. 31%), nitrate (22.9 vs. 21.1%)</div></li><li class="half_rhythm"><div>Index operation: CABG only (42.7 vs. 38.3%), valve repair only (14.9 vs. 16.5%), CABG + valve repair (3.8 vs. 2.7%), valve replacement only (22.9 vs. 25.3%), CABG + valve replacement (15.6 vs. 17.2%)</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Rehospitalisation, all-cause</div></li><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Stroke or thromboembolic complications</div></li><li class="half_rhythm"><div>Need for rescue DC cardioversion</div></li><li class="half_rhythm"><div>Rehospitalisation for AF</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li><li class="half_rhythm"><div>Hospital length of stay</div></li><li class="half_rhythm"><div>Freedom from anticoagulation</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>For both groups:</b></p><p>If patients remained in atrial fibrillation or had recurrent atrial fibrillation 48 hafter randomization, anticoagulation with warfarin (target international normalized ratio, 2 to 3) was recommended, and bridging with low-molecular-weight heparin was allowed. Anticoagulation was recommended to be continued for 60 days, unless complications occurred</p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Gray 1982<a class="bibr" href="#niceng196er13.ref37" rid="niceng196er13.ref37"><sup>37</sup></a></p><p>RCT</p><p>N=22</p><p>Conducted in USA</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Calcium channel blockers</b></p><p>Intravenous verapamil. Low-dose verapamil (0.075 mg/kg body weight, up to maximum of 10 mg) administered as bolus intravenous injection over 1 min.</p><p><b>Placebo</b></p><p>Intravenous placebo. Volume of placebo similar to that used in verapamil administration was administered as bolus intravenous injection over 1 min.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Mixed/unclear stratum: 18.1% had history of atrial tachyarrhythmias</b>
|
|
Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Development of supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter or atrial tachycardias) following open heart surgery.</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Age >74 years or <21 years</div></li><li class="half_rhythm"><div>Evidence of renal or hepatic failure</div></li><li class="half_rhythm"><div>Received propanolol24 h previously</div></li></ul>
|
|
Patient characteristics (not given separately for each group):
|
|
<ul><li class="half_rhythm"><div>Arrhythmia type: Atrial fibrillation, 81.8%; atrial flutter, 18.2%</div></li><li class="half_rhythm"><div>Type of surgery: CABG, 86.4%; double valve (aortic and mitral) replacement, 9.09%; mitral commissurotomy and aortic valve replacement, 4.56%</div></li><li class="half_rhythm"><div>Digoxin had been given in 20 patients (mean dose 0.5 mg) within the 24 h prior to verapamil administration (when verapamil used either as first drug or when used as second drug if placebo failed)</div></li></ul>
|
|
</td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Those that did not achieve positive response with first drug were switched over to the other drug, which may affect outcomes. Analysed as randomised in review unless stated otherwise.</p><p>For both groups:
|
|
<ul><li class="half_rhythm"><div>A positive response was observed if the patient converted to sinus rhythm or the heart rate decreased below 100 bpm (120 bpm in digoxin-treated patients).</div></li><li class="half_rhythm"><div>If no positive response was seen within 10 min, a higher dose of the initial intervention was administered consisting of 0.15 mg/kg verapamil or placebo equivalent.</div></li><li class="half_rhythm"><div>If no response was seen after 15 min, drug B (placebo or verapamil) was administered first in low dose and then in high dose as described for each intervention.</div></li></ul>
|
|
Digoxin had been given in 20 patients (mean dose 0.5 mg) within the 24 h prior to verapamil administration (when verapamil used either as first drug or when used as second drug if placebo failed)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Hwang 1984<a class="bibr" href="#niceng196er13.ref51" rid="niceng196er13.ref51"><sup>51</sup></a></p><p>RCT</p><p>N=14</p><p>Conducted in USA</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Calcium channel blockers</b></p><p>Intravenous verapamil. First dose of0.075 mg/kg given intravenously over 1 min.</p><p>If therapeutic end point was not achieved after 15 min, administration of verapamil was repeated at a dose of 0.15 mg/kg, up to a maximum of 10 mg.</p><p>After a further 30 min, if therapeutic end point not achieved, the second drug (placebo) was administered in a similar fashion</p><p><b>Placebo</b></p><p>Intravenous placebo. First dose of 0.075 mg/kg placebo given intravenously over 1 min.</p><p>If therapeutic end point was not achieved after 15 min, administration of placebo was repeated at a dose of 0.15 mg/kg, up to a maximum of 10 mg.</p><p>After a further 30 min, if therapeutic end point not achieved, the second drug (verapamil) was administered in a similar fashion</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: being in normal sinus rhythm prior to and immediately after surgery was inclusion criterion.</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Presence of sinus rhythm prior to and immediately following surgery</div></li><li class="half_rhythm"><div>Development of supraventricular tachycardia with a ventricular response >120 beats/min during postoperative period and persisting for at least 1 h</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Preoperative left ventricular ejection fraction <45% or clinical postoperative cardiac failure</div></li><li class="half_rhythm"><div>Hypotension (<systolic pressure below 90 mmHg)</div></li><li class="half_rhythm"><div>Notable valvular heart disease</div></li><li class="half_rhythm"><div>Impaired atrioventricular conduction or evidence of depressed sinus node automaticity</div></li><li class="half_rhythm"><div>Impaired hepatic or renal function</div></li><li class="half_rhythm"><div>Administration of beta-blocking drugs or disopyramide within previous 48 h</div></li></ul>
|
|
Patient characteristics (not given separately for each group):
|
|
<ul><li class="half_rhythm"><div>Arrhythmia type: atrial fibrillation, 78.6%; atrial flutter, 21.4%</div></li><li class="half_rhythm"><div>Mean (range) preoperative LVEF: 62 (49–74)%</div></li><li class="half_rhythm"><div>Type of surgery: aortocoronary bypass, 85.7%; aortocoronary bypass + thymectomy, 7.1%; atrial septal defect closure, 7.1%</div></li></ul>
|
|
</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Those that did not achieve positive response with first drug were switched over to the other drug, which may affect outcomes. Analysed as randomised in review unless stated otherwise.</td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kowey 2009<a class="bibr" href="#niceng196er13.ref64" rid="niceng196er13.ref64"><sup>64</sup></a></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers</b></p><p>Infusion of 3.0 mg/kg vernakalant over 10 min followed by 15 min observation period. Second infusion of 2.0 mg/kg vernakalant performed over 10 min if did not convert to sinus rhythm.</p><p><b>Placebo</b></p><p>Infusion of 3.0 mg/kg placebo (normal saline) over 10 min followed by 15 min observation period. Second infusion of 2.0 mg/kg placebo performed over 10 min if did not convert to sinus rhythm.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: being in normal sinus rhythm prior to and immediately after surgery was inclusion criterion.</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>≥18 years old with sustained AF or flutter occurring between 24 h and 7 days following surgery.</div></li><li class="half_rhythm"><div>Haemodynamically stable</div></li><li class="half_rhythm"><div>Sinus rhythm before and after surgery</div></li><li class="half_rhythm"><div>Weight between 46 and 136 kg</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Pregnancy or nursing</div></li><li class="half_rhythm"><div>Uncorrected QT interval >500 ms</div></li><li class="half_rhythm"><div>Ventricular response rate to AF <45 bpm</div></li><li class="half_rhythm"><div>QRS interval >140 ms without pacemaker</div></li><li class="half_rhythm"><div>Second or third-degree AV block</div></li><li class="half_rhythm"><div>History of torsadesde pointes</div></li><li class="half_rhythm"><div>Unstable class IV congestive heart failure, serious hepatic or renal disease, or end-stage disease states</div></li><li class="half_rhythm"><div>Reversible cause of AF (e.g. hyperthyroidism or pulmonary embolism)</div></li><li class="half_rhythm"><div>Uncorrected electrolyte imbalance</div></li><li class="half_rhythm"><div>Digoxin toxicity</div></li><li class="half_rhythm"><div>Received another investigational drug or IV vernakalant in past 30 days, received oral amiodarone with past 3 months, received IV amiodarone within past 24 h, or received class I or III antiarrhythmic drugs following cardiac surgery</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events (serious and treatment-emergent)</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Infusion was discontinued if one of various adverse effects were observed, such as uncorrected QT interval ≥550 ms or prolongation of the uncorrected QT interval >25%</td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Lee 2000<a class="bibr" href="#niceng196er13.ref68" rid="niceng196er13.ref68"><sup>68</sup></a> and Lee 2003<a class="bibr" href="#niceng196er13.ref67" rid="niceng196er13.ref67"><sup>67</sup></a></p><p>RCT</p><p>N=50</p><p>Conducted in Canada</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Mixed rhythm control with/without electrical cardioversion</b></p><p>Antiarrhythmic drug therapy with or without electrical cardioversion. Aimed at restoration of sinus rhythm within 48 h.</p><p>Preferred initial treatment was with sotalol or propafenone, taking into consideration left ventricular function, history of coronary artery disease and contraindications to beta-blockers.</p><p>Sotalol prescribed at dose of 120–360 mg/day; amiodarone at 200 mg/day after a loading dose of 1200–1600 mg for 4–5 days; and propafenone at dose of 300–900 mg/day. Procainamide given as intravenous load of 500–1000 mg followed by continuous infusion of 1–4 mg/h or 2–3 g/day in divided oral doses.</p><p>If sinus rhythm was not achieved within 48 h, patients were electrically cardioverted</p><p>Rate control therapy used in rate control group were permitted if clinically indicated (e.g. ventricular rates ≥110 per min) and in patients who received propafenone because of potential for 1:1 AV conduction during atrial fibrillation.</p><p><b>Mixed rate control</b></p><p>Preferred initial treatment was IVdiltiazem for those requiring IVagent on basis of symptom severity and beta-blockers in those treated with oral agents.
|
|
<ul><li class="half_rhythm"><div>IV diltiazem administered as initial bolus of 5–20 mg followed by continuous infusion of 5–15 mg/h.</div></li><li class="half_rhythm"><div>Oral diltiazem given at 120–360 mg/day and verapamil given orally in similar fashion.</div></li><li class="half_rhythm"><div>Metoprolol given at dose of 25–100 mg/day in 2 divided doses</div></li><li class="half_rhythm"><div>Atenolol given at dose of 25–100 mg/day</div></li><li class="half_rhythm"><div>Propanolol given at a dose of 30–120 mg in 3 divided doses</div></li><li class="half_rhythm"><div>Esmolol given at 0.05 mg/kg per minute intravenous loading followed by maintenance dose of 0.05–0.2 mg/kg per minute.</div></li><li class="half_rhythm"><div>Digoxin loading administered either intravenously or orally:
|
|
<ul class="circle"><li class="half_rhythm"><div>Oral loading dose of 0.25–0.5 mg digoxin was given followed by 0.25 mg every 4–6 hours until a loading dose of 1 mg had been given.</div></li><li class="half_rhythm"><div>Intravenous digoxin administered in similar fashion.</div></li><li class="half_rhythm"><div>Daily maintenance dose of 0.25 mg was administered thereafter for digoxin</div></li></ul></div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: those with history of paroxysmal AF or conduction disturbances at randomisation excluded</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Development of atrial fibrillation lasting at least 1 h following heart surgery</div></li><li class="half_rhythm"><div>Ability to give informed consent</div></li><li class="half_rhythm"><div>18 years of age or above</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>History of paroxysmal atrial fibrillation</div></li><li class="half_rhythm"><div>Received antiarrhythmic therapy within 5 half-lives of the time of randomisation</div></li><li class="half_rhythm"><div>Had beta-blockers withdrawn after surgery</div></li><li class="half_rhythm"><div>Were in cardiogenic shock</div></li><li class="half_rhythm"><div>Creatinine level of >200 μg/mmol</div></li><li class="half_rhythm"><div>Serum aspartate aminotransferase or alanine aminotransferase concentrations 4 times the upper limit of normal;</div></li><li class="half_rhythm"><div>Conduction disturbances before randomisation</div></li><li class="half_rhythm"><div>Contraindications to anticoagulation</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>Mean (SD) LVEF: 49 (1) vs. 47(11)%</div></li><li class="half_rhythm"><div>Preoperative beta-blockers: 63 vs. 61%</div></li><li class="half_rhythm"><div>Preoperative calcium channel blockers: 63 vs. 36%</div></li><li class="half_rhythm"><div>Valvular surgery: 30 vs. 30%</div></li><li class="half_rhythm"><div>Diabetes: 19 vs. 23%</div></li><li class="half_rhythm"><div>Hypertension: 48 vs. 52%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Hospital length of stay</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>For both groups:</b></p><p>Intravenous heparin and oral warfarin started within 24 h after randomisation.
|
|
<ul><li class="half_rhythm"><div>Dose of heparin was titrated to maintain a partial thromboplastin time between 80 and 100 seconds.</div></li><li class="half_rhythm"><div>Warfarin doses adjusted to obtain an INR between 2 and 3.</div></li><li class="half_rhythm"><div>Anticoagulation continued until end of study</div></li></ul></p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Nemati 2016<a class="bibr" href="#niceng196er13.ref84" rid="niceng196er13.ref84"><sup>84</sup></a></p><p>RCT</p><p>N=122</p><p>Conducted in Iran</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Na+ blockers</b></p><p>Oral propafenone. 600 mg loading dose and 150 mg every 8 h for 10 days after onset of atrial fibrillation.</p><p>If AF did not resolve after this first dosing strategy, it could be repeated or switched to amiodarone</p><p><b>K+ blockers</b></p><p>Intravenous amiodarone. 300 mg intravenous loading dose followed by continuous intravenous infusion of 600 mg over 12–24 h after the onset of atrial fibrillation.</p><p>If AF did not resolve after this first dosing strategy, it could be repeated or switched to propafenone</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: History of AF within previous 6 months an exclusion criterion. <10% with AF history before this period.</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Development of postoperative atrial fibrillation (continuous AF for at least 30 min or AF requiring treatment for symptoms or hemodynamic compromise) following elective coronary artery bypass grafting</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Patients that underwent concomitant cardiac operations at same time as coronary artery bypass grafting</div></li><li class="half_rhythm"><div>Bradycardia (<50 beats/min in resting position)</div></li><li class="half_rhythm"><div>Patients with > type I second-degree heart block</div></li><li class="half_rhythm"><div>Symptomatic sick sinus syndrome without a pacemaker</div></li><li class="half_rhythm"><div>Taking class I or III antiarrhythmic medications</div></li><li class="half_rhythm"><div>History of AF within past 6 months</div></li><li class="half_rhythm"><div>Sensitivity to propafenone</div></li><li class="half_rhythm"><div>Cardiogenic shock</div></li><li class="half_rhythm"><div>Ejection fraction <30%</div></li><li class="half_rhythm"><div>Marked hypotension (systolic blood pressure <90 mmHg)</div></li><li class="half_rhythm"><div>Electrolyte imbalances</div></li></ul></p><p>Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>All underwent CABG surgery</div></li><li class="half_rhythm"><div>Hypertension: 70.9 vs. 77.6%</div></li><li class="half_rhythm"><div>Hyperlipidaemia: 69.1 vs. 67.2%</div></li><li class="half_rhythm"><div>Diabetes mellitus: 50.9 vs. 49.3%</div></li><li class="half_rhythm"><div>Congestive heart failure: 0 vs. 3.1%</div></li><li class="half_rhythm"><div>Previous atrial fibrillation: 9.1 vs. 3.2%</div></li><li class="half_rhythm"><div>Drugs: beta-blockers (87.3 vs. 80.6%), calcium channel blockers (9.1 vs. 12.5%), ACE inhibitor (34.5 vs. 25.8%)</div></li></ul>
|
|
</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Need for rescue DC cardioversion</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">If the treatment strategy patients were assigned to did not resolve the AF after 10 days, treatment with drug could be repeated or switched to other drug, which could affect outcomes. Analysed as randomised in the review unless otherwise stated.</td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Qian 2008<a class="bibr" href="#niceng196er13.ref89" rid="niceng196er13.ref89"><sup>89</sup></a></p><p>RCT</p><p>N=99</p><p>Conducted in China</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Mixed rate control</b></p><p>Control of ventricular rate using digoxin and diltiazem, either alone or in combination.</p><p>Doses of drugs not stated. Appears to be oral dosing based on length of the study but not explicitly stated</p><p>Duration, 12 months.</p><p><b>K+ blockers + captopril +simvastatin</b></p><p>Pharmacological cardioversion with low-dose oral amiodarone (2 mg/kg), captopril (0.25 mg/kg) and simvastatin (0.3 mg/kg) administered daily.</p><p>Heart rate was maintained at 60–80 beats/min under quiescent conditions.</p><p>If needed, digoxin and/or diltiazem were also administered in these patients</p><p>Duration, 12 months.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Pre-existing AF: duration of AF longer than time since surgery, indicating AF present prior to surgery</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>>18 years of age</div></li><li class="half_rhythm"><div>Permanent atrial fibrillation for at least 6 months following prosthetic mitral valve replacement</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Moderate or severe tricuspid regurgitation</div></li><li class="half_rhythm"><div>NYHA heart failure class IV</div></li><li class="half_rhythm"><div>History of sick sinus syndrome or second-or third-degree atrioventricular block</div></li><li class="half_rhythm"><div>Significant thyroid, pulmonary or hepatic disease</div></li><li class="half_rhythm"><div>Contraindications to treatment with amiodarone</div></li><li class="half_rhythm"><div>Significant impairment of renal function</div></li><li class="half_rhythm"><div>Pregnancy or females shortly intending to become pregnant</div></li><li class="half_rhythm"><div>Any other medical condition that in the opinion of the investigators could make the patient inappropriate for the study</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>All received mitral valve surgery</div></li><li class="half_rhythm"><div>Mean (SD) duration of AF: 35.7 (16.1) vs. 36.3 (17.5) months</div></li><li class="half_rhythm"><div>Mean (SD) LVEF: 46 (13.1) vs. 45.7 (12.1)%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Simonpoulos 2014<a class="bibr" href="#niceng196er13.ref101" rid="niceng196er13.ref101"><sup>101</sup></a></p><p>RCT</p><p>N=41</p><p>Conducted in Greece</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers</b></p><p>IVamiodarone. 300 mg in 30 min followed by 750 mg in 24 h.</p><p>After conversion to sinus rhythm the amiodarone infusion was stopped but received amiodarone orally at a dose of 200 mg twice daily for a week and 200 mg once daily for the second week, or according to their cardiologist’s advice following discharge</p><p><b>K+ blockers + ranolazine</b></p><p>IV amiodarone at 300 mg in 30 min followed by 750 mg in 24 h. Oral ranolazine regimen consisted of 500 mg loading dose followed by 375 mg 6 hours later and then 375 mg twice daily.</p><p>After conversion to sinus rhythm the amiodarone infusion was stopped but received amiodarone orally at a dose of 200 mg twice daily for a week and 200 mg once daily for the second week, or according to their cardiologist’s advice following discharge. Ranolazine 375 mg twice daily was also continued.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: history of AF an exclusion criterion</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Development of postoperative atrial fibrillation following elective on-pump coronary artery bypass grafting</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>History of AF</div></li><li class="half_rhythm"><div>Prior antiarrhythmic therapy</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>CABG surgery in all patients</div></li><li class="half_rhythm"><div>Mean (SD) LVEF: 52.6 (8.6) vs. 53.8 (9.4)%</div></li><li class="half_rhythm"><div>Diabetes: 40 vs. 38%</div></li><li class="half_rhythm"><div>Renal insufficiency: 15 vs. 14.28%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>For both groups:</b></p><p>All patients after extubation and until discharge received a standard drug regimen that included acetylsalicylic acid (100 mg daily), atorvastatin (20–40 mg daily), the beta-blocker metoprolol (50–100 mg daily), and the angiotensin-converting enzyme inhibitor perindopril (5–10 mg daily), in addition to each patient’s individual treatment based on his or her personal medical history</p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Simonpoulos 2018<a class="bibr" href="#niceng196er13.ref100" rid="niceng196er13.ref100"><sup>100</sup></a></p><p>RCT</p><p>N=812</p><p>Conducted in Greece</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers</b></p><p>IV amiodarone. Loading dose of 300 mg in 30 min followed by 750 mg in 24 h.</p><p>If arrhythmia was sustained after 24 h, further 375 mg given in 12 h. Maximum recording period of 36 h.</p><p>After conversion to sinus rhythm amiodarone infusion was discontinued and treatment with amiodarone 200 mg t.i.d was continued until hospital discharge</p><p><b>K+ blockers + ranolazine</b></p><p>IVamiodarone + oral ranolazine. Amiodarone loading dose of 300 mg in 30 min followed by 750 mg in 24 h.</p><p>If arrhythmia was sustained after 24 h, further 375 mg given in 12 h. Maximum recording period of 36 h.</p><p>500 mg ranolazine was administered once at time of randomisation, followed by 375 mg 6 h later and subsequently 375 mg twice daily.</p><p>After conversion to sinus rhythm amiodarone infusion was discontinued and treatment with amiodarone 200 mg t.i.dand375 mg b.i.dranolazine was continued until hospital discharge</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF stratum: persistent or permanent AF in previous 6 months exclusion criterion</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Those that underwent coronary artery bypass grafting</div></li><li class="half_rhythm"><div>Development of atrial fibrillation 2–3 days following operation</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Previously documented persistent of permanent AF in last 6 months prior to surgery</div></li><li class="half_rhythm"><div>ReceivingCYP3A inhibitors or inducers</div></li><li class="half_rhythm"><div>History of hepatic or renal failure</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>All underwent CABG surgery</div></li><li class="half_rhythm"><div>Mean (SD) LVEF: 42.65 (8.98) vs. 43.24 (9.7)%</div></li><li class="half_rhythm"><div>Prior myocardial infarction: 53.8 vs. 59%</div></li><li class="half_rhythm"><div>Type II diabetes: 54.6 vs. 53.8%</div></li><li class="half_rhythm"><div>Hypertension: 58.5 vs. 54.3%</div></li><li class="half_rhythm"><div>Medications:</div></li><li class="half_rhythm"><div>Beta-blockers: 84.0 vs. 81.8%</div></li><li class="half_rhythm"><div>Digoxin: 0.2 vs. 0%</div></li><li class="half_rhythm"><div>ACE inhibitors/ARBs: 65.9 vs. 66.8%</div></li><li class="half_rhythm"><div>Statins: 58.3 vs. 68.6%</div></li><li class="half_rhythm"><div>Dihydropyridines: 24.7 vs. 32.9%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>For both groups:</b></p><p>On first postoperative day, all given LMWH and acetylsalicylic acid 100 mg once daily, which was continued during the AF and conversion to sinus rhythm. Where sinus rhythm was not restored with 36 h, anticoagulation was changed to acenocoumarol4 mg and adjusted according to INR</p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Vilvanathan 2016<a class="bibr" href="#niceng196er13.ref110" rid="niceng196er13.ref110"><sup>110</sup></a></p><p>RCT</p><p>N=89</p><p>Conducted in India</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>K+ blockers + DC cardioversion</b></p><p>Amiodarone + DC cardioversion. DC cardioversion performed 48 h after balloon mitral valvuloplasty.</p><p>Cardioversion:
|
|
<ul><li class="half_rhythm"><div>Prior to DC cardioversion, patients sedated and given analgesia.</div></li><li class="half_rhythm"><div>Synchronised DC cardioversion was given using biphasic defibrillators using the following protocol: 100J, 200J, 300J and 360 J.</div></li><li class="half_rhythm"><div>Unsuccessful DC cardioversion was considered to include those who did not revert with 360J.</div></li></ul>
|
|
K+ blockers:
|
|
<ul><li class="half_rhythm"><div>Amiodarone was given as an intravenous bolus of 150 mg followed by a 1 g intravenous infusion for 12 h prior to DC cardioversion.</div></li><li class="half_rhythm"><div>Following cardioversion, oral amiodarone was started initially 200 mg three times a day for 2 weeks, followed by 200 mg twice daily for 2 weeks and subsequently 200 mg once daily for 12 months</div></li></ul>
|
|
<b>Placebo + DC cardioversion</b></p><p>Cardioversion:
|
|
<ul><li class="half_rhythm"><div>DC cardioversion was performed 48 h after balloon mitral valvuloplasty.</div></li><li class="half_rhythm"><div>Prior to DC cardioversion, patients were sedated and received analgesia.</div></li><li class="half_rhythm"><div>Synchronised DC cardioversion was given using biphasic defibrillators using the following protocol: 100J, 200J, 300J and 360 J.</div></li><li class="half_rhythm"><div>Unsuccessful DC cardioversion was considered to include those who did not revert with 360J.</div></li></ul></p><p>Placebo:
|
|
<ul><li class="half_rhythm"><div>No preloading with amiodarone prior to DC cardioversion</div></li><li class="half_rhythm"><div>Following DC cardioversion, patients received placebo for 12 months</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Pre-existing AF stratum: all had permanent AF for at least 3 months prior to mitral valvuloplasty</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Aged >18 years</div></li><li class="half_rhythm"><div>Underwent successful balloon mitral valvuloplasty</div></li><li class="half_rhythm"><div>ECG evidence of atrial fibrillation for >3 months</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Prior history of cardioversion</div></li><li class="half_rhythm"><div>Significant mitral, tricuspid or aortic regurgitation</div></li><li class="half_rhythm"><div>Significant tricuspid or aortic stenosis</div></li><li class="half_rhythm"><div>Left atrial thrombus (detected by transoesophageal echocardiography)</div></li><li class="half_rhythm"><div>Left atrial diameter ≥6 cm</div></li><li class="half_rhythm"><div>Inability to comply with 12 months follow-up period</div></li><li class="half_rhythm"><div>Contraindications to anticoagulation or amiodarone</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>Mean (SD) duration of AF: 10.05 (5.718) vs. 10.27 (5.495) months</div></li><li class="half_rhythm"><div>Hypertension: 4.5 vs. 6.7%</div></li><li class="half_rhythm"><div>Diabetes: 4.5 vs. 2.2%</div></li><li class="half_rhythm"><div>Hypertension + diabetes: 2.3 vs. 4.4%</div></li><li class="half_rhythm"><div>Diabetes + coronary heart disease: 2.3 vs. 0%</div></li><li class="half_rhythm"><div>NYHA class: I (20.5 vs. 4.4%), II (63.6 vs. 75.6%), III (11.4 vs. 13.3%) and IV (4.5 vs. 6.7%)</div></li><li class="half_rhythm"><div>Concomitant drugs:
|
|
<ul><li class="half_rhythm"><div>Beta-blockers: 48.9 vs. 43.2%</div></li><li class="half_rhythm"><div>Calcium channel blockers: 24.4 vs. 22.7%</div></li><li class="half_rhythm"><div>Digoxin: 64.4 vs. 68.2%</div></li></ul></div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Health-related quality of life</div></li><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>For both groups:</b></p><p>Patients were anticoagulated with warfarin and INR was required to be between 2 and 3 for at least 1 month prior to DC cardioversion</p></td></tr><tr><td headers="hd_h_niceng196er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Wafa 1989<a class="bibr" href="#niceng196er13.ref111" rid="niceng196er13.ref111"><sup>111</sup></a></p><p>RCT</p><p>N=29</p><p>Conducted in UK</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Na+ blockers</b></p><p>Intravenous flecainide. Bolus of 1 mg/kg body weight over 10 min followed by an infusion of 1.5 mg/kg/h for 1 h and another infusion of 0.25 mg/kg/h for the rest of the 24 h study period</p><p>A single dose of verapamil (10 mg intravenously) was given over a 5 min period if after 45 min reversion to sinus rhythm and adequate ventricular rate control (<100 beats/min) had not been achieved.</p><p><b>Digoxin</b></p><p>Intravenous digoxin. Bolus of 0.5 mg over 10 min followed after 6 and 12 h by bolus doses of 0.25 mg over 10 min</p><p>A single dose of verapamil (10 mg intravenously) was given over a 5 min period if after 45 min reversion to sinus rhythm and adequate ventricular rate control (<100 beats/min) had not been achieved.</p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>No pre-existing AF: preoperative atrial arrhythmias an exclusion criterion</b></p><p>Inclusion criteria:
|
|
<ul><li class="half_rhythm"><div>18–80 years of age</div></li><li class="half_rhythm"><div>CABG complicated within 96 h after surgery by atrial tachyarrhythmias (atrial fibrillation, atrial flutter or atrial tachycardia) lasting at least 15 min with a ventricular rate >120 beats/min</div></li></ul>
|
|
Exclusion criteria:
|
|
<ul><li class="half_rhythm"><div>Preoperative atrial arrhythmia</div></li><li class="half_rhythm"><div>Second- or third-degree atrioventricular block</div></li><li class="half_rhythm"><div>Presence or history of bifascicular block or bundle branch block with any degree of atrioventricular block</div></li><li class="half_rhythm"><div>Known sinus node dysfunction in the absence of a pacing wire</div></li><li class="half_rhythm"><div>Impaired left ventricular dysfunction (as detected clinically and angiographically)</div></li><li class="half_rhythm"><div>Treatment with other antiarrhythmics (including verapamil) during anaesthesia or since return to intensive care unit</div></li><li class="half_rhythm"><div>Treatment with digoxin or beta-blockers in the 24h before entry into the study</div></li><li class="half_rhythm"><div>Serious renal or hepatic disease</div></li><li class="half_rhythm"><div>Receipt of any investigational drug during the 4-weeks prior to the study</div></li><li class="half_rhythm"><div>Receipt of any antiarrhythmic agents within 3 elimination half-lives of the date of inclusion in the study</div></li></ul>
|
|
Patient characteristics:
|
|
<ul><li class="half_rhythm"><div>Type of operation: CABG alone (93.3 vs. 92.9%) and CABG + aortic valve replacement (6.7 vs. 7.1%)</div></li><li class="half_rhythm"><div>Arrhythmia type: atrial fibrillation (100 vs. 85.7%) and atrial flutter (0 vs. 14.3%)</div></li><li class="half_rhythm"><div>Coronary artery disease: 100% vs. 100%</div></li><li class="half_rhythm"><div>Aortic valve disease: 6.7 vs. 7.1%</div></li></ul></p></td><td headers="hd_h_niceng196er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Achievement of sinus rhythm</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_niceng196er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab3"><div id="niceng196er13.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: Evidence not suitable for GRADE analysis</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng196er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng196er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparator</th><th id="hd_h_niceng196er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng196er13.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention results</th><th id="hd_h_niceng196er13.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention group (n)</th><th id="hd_h_niceng196er13.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comparatorresults</th><th id="hd_h_niceng196er13.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comparatorgroup (n)</th><th id="hd_h_niceng196er13.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gillinov2016<a class="bibr" href="#niceng196er13.ref35" rid="niceng196er13.ref35"><sup>35</sup></a></td><td headers="hd_h_niceng196er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>No pre-existing AF stratum:</b> Mixed rate control vs. K+ blocker with/without rate control agent</td><td headers="hd_h_niceng196er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital length of stay at 60 days</td><td headers="hd_h_niceng196er13.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (IQR): 5.1 (3–7.4) days</td><td headers="hd_h_niceng196er13.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">262</td><td headers="hd_h_niceng196er13.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (IQR): 5.0 (3.2–7.5) days</td><td headers="hd_h_niceng196er13.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">261</td><td headers="hd_h_niceng196er13.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_niceng196er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hwang1984<a class="bibr" href="#niceng196er13.ref51" rid="niceng196er13.ref51"><sup>51</sup></a></td><td headers="hd_h_niceng196er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>No pre-existing AF stratum:</b> Calcium channel blockers vs. placebo</td><td headers="hd_h_niceng196er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Achievement of sinus rhythm at end of hospital stay – note results given ‘as received’.</p><p>All patients in placebo group switched to verapamil as treatment failed within required time-frame. Study reports total number of all participants in study that were in sinus rhythm after treatment with verapamil</p></td><td headers="hd_h_niceng196er13.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">At end of study,3/14 remained in sinus rhythm at the end of their hospital stay. Of these, 2 had been receiving oral doses of digoxin or propanololhydro chloride, but none maintained on oral doses of verapamil</td><td headers="hd_h_niceng196er13.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 (those originally assigned to calcium channel blockers and all those assigned to placebo switched following failure)</td><td headers="hd_h_niceng196er13.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_niceng196er13.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_niceng196er13.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very high</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab4"><div id="niceng196er13.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Mixed/unclear stratum– calcium channel blockers vs. placebo</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab4_1_1_1_5" id="hd_h_niceng196er13.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with placebo</th><th headers="hd_h_niceng196er13.tab4_1_1_1_5" id="hd_h_niceng196er13.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Calcium channel blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (adverse reaction or unusual haemodynamic response)</td><td headers="hd_h_niceng196er13.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>22</p><p>(1 study)</p><p>hours</p></td><td headers="hd_h_niceng196er13.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>b</sup><sup>,</sup><sup>c</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD: 0 (−0.16 to 0.16)</td><td headers="hd_h_niceng196er13.tab4_1_1_1_5 hd_h_niceng196er13.tab4_1_1_2_1 hd_h_niceng196er13.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab4_1_1_1_5 hd_h_niceng196er13.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab4_1_1_1_5 hd_h_niceng196er13.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 160 fewer to 160 more)<sup>a</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab4_1"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms of the study.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab4_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab4_3"><p class="no_margin">>10% with atrial flutter rather than atrial fibrillation</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab4_4"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms of the study. Sample size <70 so very serious imprecision.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab5"><div id="niceng196er13.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: No pre-existing AFstratum– DC cardioversion vs. K+ blockers</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab5_1_1_1_5" id="hd_h_niceng196er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blockers</th><th headers="hd_h_niceng196er13.tab5_1_1_1_5" id="hd_h_niceng196er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with DC cardioversion (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 24 h)</td><td headers="hd_h_niceng196er13.tab5_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>18</p><p>(1 study)</p><p>24 hours</p></td><td headers="hd_h_niceng196er13.tab5_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab5_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.33 (0.09 to 1.23)</td><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_1 hd_h_niceng196er13.tab5_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">667 per 1000</td><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>447 fewer per 1000</p><p>(from 607 fewer to 153 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Need for rescue DC cardioversion (need for transthoracic cardioversion post-24 h - follow-up unclear)</td><td headers="hd_h_niceng196er13.tab5_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>11</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab5_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab5_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 0.16 (0 to 8.19)</td><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_1 hd_h_niceng196er13.tab5_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">167 per 1000</td><td headers="hd_h_niceng196er13.tab5_1_1_1_5 hd_h_niceng196er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>167 fewer per 1000</p><p>(from 543 fewer to 209 more)<sup>c</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab5_3"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in one arm of single study.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab6"><div id="niceng196er13.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: No pre-existing AFstratum– K+ blockers vs. digoxin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab6_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab6_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab6_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab6_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab6_1_1_1_5" id="hd_h_niceng196er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Digoxin</th><th headers="hd_h_niceng196er13.tab6_1_1_1_5" id="hd_h_niceng196er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with K+ blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 24 h)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>30</p><p>(1 study)</p><p>24 hours</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.17 (0.88 to 1.55)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1 hd_h_niceng196er13.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">800 per 1000</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>136 more per 1000</p><p>(from 96 fewer to 440 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (clinically significant hypotension or cardiac conduction abnormalities)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>30</p><p>(1 study)</p><p>24 hours</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD: 0 (−0.12 to 0.12)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1 hd_h_niceng196er13.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 120 fewer to 120 more)<sup>c</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Need for rescue DC cardioversion (direct current reversion post24 h - follow-up unclear)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>30</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 0.14 (0 to 6.82)</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1 hd_h_niceng196er13.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67 per 1000</td><td headers="hd_h_niceng196er13.tab6_1_1_1_5 hd_h_niceng196er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>67 fewer per 1000</p><p>(from 233 fewer to 100 more)<sup>e</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab6_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab6_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab6_3"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms of the study.</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab6_4"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms of the study. Sample size <70so very serious imprecision.</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng196er13.tab6_5"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in one arm of the study.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab7"><div id="niceng196er13.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– K+ blockers vs. K+ blockers + ranolazine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab7_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab7_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab7_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab7_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab7_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab7_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab7_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab7_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab7_1_1_1_5" id="hd_h_niceng196er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blocker + ranolazine</th><th headers="hd_h_niceng196er13.tab7_1_1_1_5" id="hd_h_niceng196er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with K+ blockers alone (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab7_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 36 h/unclear)</td><td headers="hd_h_niceng196er13.tab7_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>853</p><p>(2 studies)</p></td><td headers="hd_h_niceng196er13.tab7_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab7_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1 (0.99 to 1.01)</td><td headers="hd_h_niceng196er13.tab7_1_1_1_5 hd_h_niceng196er13.tab7_1_1_2_1 hd_h_niceng196er13.tab7_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab7_1_1_1_5 hd_h_niceng196er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100 per 1000</td><td headers="hd_h_niceng196er13.tab7_1_1_1_5 hd_h_niceng196er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 10 fewer to 10 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab7_1"><p class="no_margin">Downgraded by 1 increment if the majority o fthe evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab8"><div id="niceng196er13.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– mixed rate control vs. K+ blockers with/without rate control agent</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab8_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab8_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab8_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab8_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab8_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab8_1_1_1_5" id="hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blocker with/without rate control agent</th><th headers="hd_h_niceng196er13.tab8_1_1_1_5" id="hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with mixed rate control (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at hospital discharge)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>518</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, indirectness</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.96 (0.91 to 1.01)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1 hd_h_niceng196er13.tab8_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">934 per 1000</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>37 fewer per 1000</p><p>(from 84 fewer to 9 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (serious and nonserious adverse events, other than cerebrovascular/non-cerebral thromboembolism)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rate ratio 0.96 (0.77 to 1.2)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients could have more than one event included in rate count.</p><p>Event rate per 100 patient-months: 31.4.</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.3 fewer per 100 patient-months(from 8.22 fewer to 5.58 more)<sup>c</sup><sup>,</sup><sup>d</sup></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Freedom from anticoagulation (no warfarin prescription at hospital discharge)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, indirectness</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.01 (0.87 to 1.17)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1 hd_h_niceng196er13.tab8_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">567 per 1000</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>6 more per 1000</p><p>(from 74 fewer to 96 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (mortality at 60 days)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 1.49 (0.26 to 8.66)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1 hd_h_niceng196er13.tab8_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 per 1000</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>4 more per 1000</p><p>(from 6 fewer to 57 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Need for rescue DC cardioversion (direct current cardioversion at 60 days)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.66 (0.41 to 1.08)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1 hd_h_niceng196er13.tab8_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">138 per 1000</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>47 fewer per 1000</p><p>(from 81 fewer to 11 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rehospitalisation, all-cause (readmission due to any cause at 60 days)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rate ratio 1.0 (0.73to 1.37)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients could have more than one event included in rate count.</p><p>Event rate per 100 patient-months: 18.5.</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 fewer per 100-patient-months(from 5.77fewer to 5.74 more)<sup>c</sup><sup>,</sup><sup>d</sup></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rehospitalisation for AF (readmission due to treatment of AF at 60 days)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rate ratio 0.67 (0.31 to 1.42)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients could have more than one event included in rate count.</p><p>Event rate per 100 patient-months: 3.9</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.3 fewer per 100 patient-months(from 3.71 fewer to 1.12 more)<sup>c</sup><sup>,</sup><sup>d</sup></td></tr><tr><td headers="hd_h_niceng196er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stroke or thromboembolic complications (serious and non-serious cerebrovascular, inc, stroke and TIA, and/or non-cerebral thromboembolism at 60 days)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>523</p><p>(1 study)</p><p>60 days</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rate ratio 2.33 (0.6to 9.02)</td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients could have more than one event included in rate count.</p><p>Event rate per 100 patient-months: 0.6</p></td><td headers="hd_h_niceng196er13.tab8_1_1_1_5 hd_h_niceng196er13.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.8more per 100 patient-months(from 0.44fewer to 2.04 more)<sup>c</sup><sup>,</sup><sup>d</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab8_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab8_2"><p class="no_margin">Unclear which rate control agents were included - could include some not listed in our protocol</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab8_3"><p class="no_margin">Per100 patient-months.</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab8_4"><p class="no_margin">Absolute effect calculated manually using difference in rates per 100 patient months</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng196er13.tab8_5"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab9"><div id="niceng196er13.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– mixed rhythm control +/- electrical cardioversion vs. mixed rate control</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab9_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab9_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab9_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab9_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab9_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab9_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab9_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab9_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab9_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab9_1_1_1_5" id="hd_h_niceng196er13.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with mixed rate control</th><th headers="hd_h_niceng196er13.tab9_1_1_1_5" id="hd_h_niceng196er13.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with mixed rhythm control +/- electrical cardioversion (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 8 weeks post-hospital discharge)</td><td headers="hd_h_niceng196er13.tab9_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>50</p><p>(1 study)</p><p>8 weeks post-hospital discharge</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, indirectness</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.05 (0.91 to 1.22)</td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_1 hd_h_niceng196er13.tab9_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">913 per 1000</td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>46 more per 1000</p><p>(from 82 fewer to 201 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (mortality at 8 weeks post-hospital discharge)</td><td headers="hd_h_niceng196er13.tab9_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>50</p><p>(1 study)</p><p>8 weeks post-hospital discharge</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 6.62 (0.4 to 109.94)</td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_1 hd_h_niceng196er13.tab9_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>74 more per 1000</p><p>(from 46 fewer to 194 more)<sup>c</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital length of stay (from surgery to discharge)</td><td headers="hd_h_niceng196er13.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>50</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, indirectness</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean hospital length of stay (from surgery to discharge) in the control groups was</p><p>9.7 days</p></td><td headers="hd_h_niceng196er13.tab9_1_1_1_5 hd_h_niceng196er13.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean hospital length of stay (from surgery to discharge) in the intervention groups was</p><p>2.3 lower</p><p>(2.72 to 1.88 lower)</p><p>Note: MID was deemed to be 0.5days (based on 0.5 x median sd[1.0] in mixed rate control group)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab9_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab9_2"><p class="no_margin">Serious indirectness as some in the mixed rate control arm could have received intravenous diltiazem - not available in UK in this form. Proportion unclear.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab9_3"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in control group</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab9_4"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab10"><div id="niceng196er13.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. digoxin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab10_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab10_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab10_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab10_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab10_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab10_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab10_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab10_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab10_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab10_1_1_1_5" id="hd_h_niceng196er13.tab10_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with digoxin</th><th headers="hd_h_niceng196er13.tab10_1_1_1_5" id="hd_h_niceng196er13.tab10_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Na+ blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab10_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 24 h)</td><td headers="hd_h_niceng196er13.tab10_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>29</p><p>(1 study)</p><p>24 hours</p></td><td headers="hd_h_niceng196er13.tab10_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab10_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.31 (0.91 to 1.87)</td><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_1 hd_h_niceng196er13.tab10_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">714 per 1000</td><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>221 more per 1000</p><p>(from 64 fewer to 621 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab10_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (adverse reactions at 24 h)</td><td headers="hd_h_niceng196er13.tab10_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>29</p><p>(1 study)</p><p>24 hours</p></td><td headers="hd_h_niceng196er13.tab10_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab10_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 8.02 (0.76 to 84.1)</td><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_1 hd_h_niceng196er13.tab10_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab10_1_1_1_5 hd_h_niceng196er13.tab10_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>200 more per 1000</p><p>(from 22 fewer to 422 more)<sup>c</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab10_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab10_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab10_3"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in control group</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab11"><div id="niceng196er13.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– Na+ blockers vs. K+ blockers</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab11_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab11_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab11_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab11_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab11_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab11_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab11_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab11_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab11_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab11_1_1_1_5" id="hd_h_niceng196er13.tab11_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blockers</th><th headers="hd_h_niceng196er13.tab11_1_1_1_5" id="hd_h_niceng196er13.tab11_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Na+ blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (without electrical cardioversion at end of study - includes those switching drug)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>122</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.01 (0.94 to 1.09)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1 hd_h_niceng196er13.tab11_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">955 per 1000</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>10 more per 1000</p><p>(from 57 fewer to 86 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (significant side effects at end of study)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>122</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD: 0 (−0.03 to 0.03)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1 hd_h_niceng196er13.tab11_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 30 fewer to 30 more)<sup>b</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Need for rescue DC cardioversion (cardioversion at end of study)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>122</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab11_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.81 (0.14 to 4.69)</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1 hd_h_niceng196er13.tab11_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45 per 1000</td><td headers="hd_h_niceng196er13.tab11_1_1_1_5 hd_h_niceng196er13.tab11_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>9 fewer per 1000</p><p>(from 39 fewer to 166 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab11_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab11_2"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms of the study.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab11_3"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms of the study. Sample size >70 and <350 so serious imprecision.</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab11_4"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab12"><div id="niceng196er13.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Clinical evidence summary: No pre-existing AFstratum– Calcium channel blockers vs. placebo</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab12_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab12_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab12_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab12_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab12_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab12_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab12_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab12_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab12_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab12_1_1_1_5" id="hd_h_niceng196er13.tab12_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with placebo</th><th headers="hd_h_niceng196er13.tab12_1_1_1_5" id="hd_h_niceng196er13.tab12_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with calcium channel blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab12_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (adverse events requiring premature termination of study, such as hypotension or bradycardia - in-hospital)</td><td headers="hd_h_niceng196er13.tab12_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>14</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab12_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>b</sup><sup>,</sup><sup>c</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er13.tab12_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (−0.24 to 0.24)</td><td headers="hd_h_niceng196er13.tab12_1_1_1_5 hd_h_niceng196er13.tab12_1_1_2_1 hd_h_niceng196er13.tab12_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab12_1_1_1_5 hd_h_niceng196er13.tab12_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab12_1_1_1_5 hd_h_niceng196er13.tab12_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 240 fewer to 240 more)<sup>a</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab12_1"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms of the study.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab12_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab12_3"><p class="no_margin">>10% with atrial flutter rather than atrial fibrillation</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab12_4"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms of the study. Sample size <70 so very serious imprecision.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab13"><div id="niceng196er13.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">Clinical evidence summary: No pre-existing AFstratum– K+ blockers (vernakalant) vs. placebo</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab13_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab13_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab13_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab13_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab13_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab13_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab13_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab13_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab13_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab13_1_1_1_5" id="hd_h_niceng196er13.tab13_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with placebo</th><th headers="hd_h_niceng196er13.tab13_1_1_1_5" id="hd_h_niceng196er13.tab13_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with No pre-existing AF stratum: K+ blockers (vernakalant) (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng196er13.tab13_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>160</p><p>(1 study)</p><p>30 days</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>b</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (−0.03 to 0.03)</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1 hd_h_niceng196er13.tab13_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 30 fewer to 30 more)<sup>a</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm</td><td headers="hd_h_niceng196er13.tab13_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>161</p><p>(1 study)</p><p>90 min</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>b</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>RR 3.03</p><p>(1.54 to 5.94)</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1 hd_h_niceng196er13.tab13_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">148 per 1000</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>300 more per 1000</p><p>(from 80 more to 731 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Serious adverse events</td><td headers="hd_h_niceng196er13.tab13_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>161</p><p>(1 study)</p><p>30 days</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>b</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.84 (0.32 to 2.19)</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1 hd_h_niceng196er13.tab13_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">111 per 1000</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>18 fewer per 1000</p><p>(from 75 fewer to 132 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Treatment-emergent adverse events</td><td headers="hd_h_niceng196er13.tab13_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>161</p><p>(1 study)</p><p>24 h</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>b</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab13_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.22 (0.77 to 1.93)</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1 hd_h_niceng196er13.tab13_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">315 per 1000</td><td headers="hd_h_niceng196er13.tab13_1_1_1_5 hd_h_niceng196er13.tab13_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>69 more per 1000</p><p>(from 72 fewer to 293 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab13_1"><p class="no_margin">Absolute risk calculated manually using risk difference as zero events in both arms of the study</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab13_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab13_3"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms of the study. Sample size >70 and <350 so serious imprecision</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab13_4"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab14"><div id="niceng196er13.tab14" class="table"><h3><span class="label">Table 14</span><span class="title">Clinical evidence summary: No pre-existing AF stratum– K+ blockers (amiodarone) vs. routine medical treatment alone</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab14/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab14_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab14_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab14_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab14_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab14_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab14_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab14_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab14_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab14_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab14_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab14_1_1_1_5" id="hd_h_niceng196er13.tab14_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with routine medical treatment alone</th><th headers="hd_h_niceng196er13.tab14_1_1_1_5" id="hd_h_niceng196er13.tab14_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with K+ blockers (amiodarone) (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab14_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm</td><td headers="hd_h_niceng196er13.tab14_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>84</p><p>(1 study)</p><p>unclear</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.43 (0.84 to 2.43)</td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_1 hd_h_niceng196er13.tab14_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">333 per 1000</td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>143 more per 1000</p><p>(from 53 fewer to 476 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital length of stay</td><td headers="hd_h_niceng196er13.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>84</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊕⊝</p><p>MODERATE<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean hospital length of stay in the control groups was</p><p>14.07 days</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean hospital length of stay in the intervention groups was</p><p>3.83 lower</p><p>(4.32 to 3.34 lower)</p><p>Note: MID was deemed to be 0.59days (based on 0.5 x median sd[1.17] in routine medical treatment group)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU length of stay</td><td headers="hd_h_niceng196er13.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>84</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊕⊝</p><p>MODERATE<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean ICU length of stay in the control groups was</p><p>2.83 days</p></td><td headers="hd_h_niceng196er13.tab14_1_1_1_5 hd_h_niceng196er13.tab14_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean ICU length of stay in the intervention groups was</p><p>1.14 lower</p><p>(1.54 to 0.74 lower)</p><p>Note: MID was deemed to be 0.48days (based on 0.5 x median sd[0.95] in routine medical treatment group)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab14_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab14_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab15"><div id="niceng196er13.tab15" class="table"><h3><span class="label">Table 15</span><span class="title">Clinical evidence summary: Pre-existing AF stratum– DC cardioversion vs. K+ blockers + captopril + simvastatin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab15/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab15_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab15_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab15_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab15_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab15_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab15_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab15_1_1_1_5" id="hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blockers+ captopril + simvastatin</th><th headers="hd_h_niceng196er13.tab15_1_1_1_5" id="hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with DC cardioversion (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at end of treatment)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>115</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊕⊝</p><p>MODERATE<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 3.67 (2.38 to 5.67)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">268 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>716 more per 1000</p><p>(from 370 more to 1000 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (severe complications at follow-up)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>115</p><p>(1 study)</p><p>3–34 months</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (−0.03 to 0.03)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 30 fewer to 30 more)<sup>b</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (severe cough during treatment)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>115</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 0.13 (0.01 to 2.04)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>36 fewer per 1000</p><p>(from 94 fewer to 22 more)<sup>d</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (sinus bradycardia with heart rate of 43–52 bpm during treatment)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>115</p><p>(1 study)</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 7.14 (0.44 to 115.75)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>34 more per 1000</p><p>(from 22 fewer to 90 more)<sup>f</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (mortality at follow-up)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>115</p><p>(1 study)</p><p>3–34 months</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (−0.03 to 0.03)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 30 fewer to 30 more)<sup>b</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Rehospitalisation for AF (recurrence of AF at follow-up)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>73</p><p>(1 study)</p><p>3–34 months</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab15_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.52 (0.05 to 5.33)</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1 hd_h_niceng196er13.tab15_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67 per 1000</td><td headers="hd_h_niceng196er13.tab15_1_1_1_5 hd_h_niceng196er13.tab15_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>32 fewer per 1000</p><p>(from 64 fewer to 290 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab15_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab15_2"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms of the study</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab15_3"><p class="no_margin">Imprecision assessed using sample size as zero events in both arms. Sample size >70 and <350 so serious imprecision.</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab15_4"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in one arm of single study</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng196er13.tab15_5"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng196er13.tab15_6"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in the control group</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab16"><div id="niceng196er13.tab16" class="table"><h3><span class="label">Table 16</span><span class="title">Clinical evidence summary: Pre-existing AF stratum– Mixed rate control vs. K+ blockers + captopril + simvastatin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab16/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab16_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab16_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab16_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab16_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab16_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab16_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab16_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab16_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab16_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab16_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab16_1_1_1_5" id="hd_h_niceng196er13.tab16_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with K+ blockers+ captopril + simvastatin</th><th headers="hd_h_niceng196er13.tab16_1_1_1_5" id="hd_h_niceng196er13.tab16_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with mixed rate control (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab16_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm conversion at 12 months)</td><td headers="hd_h_niceng196er13.tab16_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>99</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab16_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊕⊝</p><p>MODERATE<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab16_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.15 (0.05 to 0.49)</td><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_1 hd_h_niceng196er13.tab16_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">388 per 1000</td><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>330 fewer per 1000</p><p>(from 198 fewer to 369 fewer)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab16_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (adverse events requiring discontinuation of one or more study drugs at 12 months)</td><td headers="hd_h_niceng196er13.tab16_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>98</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab16_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab16_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 0.11 (0.02 to 0.52)</td><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_1 hd_h_niceng196er13.tab16_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">146 per 1000</td><td headers="hd_h_niceng196er13.tab16_1_1_1_5 hd_h_niceng196er13.tab16_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>146 fewer per 1000</p><p>(from 250 fewer to 42 more)<sup>b</sup></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab16_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab16_2"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in one arm of the study</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab17"><div id="niceng196er13.tab17" class="table"><h3><span class="label">Table 17</span><span class="title">Clinical evidence summary: Pre-existing AF stratum– K+ blockers + DC cardioversion vs. placebo + DC cardioversion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab17/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab17_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab17_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab17_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er13.tab17_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab17_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participa nts (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er13.tab17_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab17_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er13.tab17_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er13.tab17_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er13.tab17_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er13.tab17_1_1_1_5" id="hd_h_niceng196er13.tab17_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with placebo + DC cardioversion</th><th headers="hd_h_niceng196er13.tab17_1_1_1_5" id="hd_h_niceng196er13.tab17_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with K+ blockers + DC cardioversion (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Achievement of sinus rhythm (sinus rhythm at 12 months)</td><td headers="hd_h_niceng196er13.tab17_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>73</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 3.23 (1.58 to 6.61)</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1 hd_h_niceng196er13.tab17_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">189 per 1000</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>421 more per 1000</p><p>(from 110 more to 1000 more)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (dose reduction due to adverse events at 12 months)</td><td headers="hd_h_niceng196er13.tab17_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>89</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>a</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PetoOR 9.25 (2.35 to 36.43)</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1 hd_h_niceng196er13.tab17_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>205 more per 1000</p><p>(from 82 more to 328 more)<sup>b</sup></p></td></tr><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Health-related quality of life (mental component score SF-8 at 12 months)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>73</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean health-related quality of life (mental component score sf-8 at 12 months) in the control groups was</p><p>50.15</p><p>Baseline value, mean (SD, n): 43.94</p><p>(5.276, n=45)</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean health-related quality of life (mental component score sf-8 at 12 months) in the intervention groups was</p><p>3.74 higher</p><p>(1.1 to 6.38 higher)</p><p>Baseline value, mean (SD, n): 45.08</p><p>(4.928, n=44)</p><p>Note: MID was deemed to be 2.61(based on 0.5 x median sd[5.216] in placebo + DC cardioversion group)</p></td></tr><tr><td headers="hd_h_niceng196er13.tab17_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Health-related quality of life (physical component score SF-8 at 12 months)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>73</p><p>(1 study)</p><p>12 months</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean health-related quality of life (physical component score sf-8 at 12 months) in the control groups was</p><p>46.62</p><p>Baseline value, mean (SD, n): 46.46</p><p>(4.628, n=45)</p></td><td headers="hd_h_niceng196er13.tab17_1_1_1_5 hd_h_niceng196er13.tab17_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean health-related quality of life (physical component score sf-8 at 12 months) in the intervention groups was</p><p>3.17 higher</p><p>(0.24 to 6.1 higher)</p><p>Baseline value, mean (SD, n): 48.03</p><p>(5.005, n=44);</p><p>Note: MID was deemed to be 2.96(based on 0.5 x median sd[5.917] in placebo + DC cardioversion group)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er13.tab17_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er13.tab17_2"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in control group of study</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er13.tab17_3"><p class="no_margin">Downgraded by 1 increment as the confidence intervals crossed the upper MID of 2.61</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er13.tab17_4"><p class="no_margin">Downgraded by 1 increment as the confidence intervals crossed the upper MID of 2.96</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab18"><div id="niceng196er13.tab18" class="table"><h3><span class="label">Table 18</span><span class="title">Drug unit costs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab18/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab18_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class</th><th id="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug (preparation)</th><th id="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dose range</th><th id="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost range per day</th><th id="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost range per year</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="3" colspan="1" style="text-align:left;vertical-align:top;">Class IC (Na+ channel blockers)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Disopyramide (capsules)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">300mg to 800 mg daily in divided doses</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.79 to £2.10</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£287.22 to £765.92</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Flecainide acetate (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50mg bd to 300mg daily</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.16 to £0.26</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£59.13 to £93.26</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Propafenone hydrochloride(tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">150mg tid to 300mg tid</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.25 to £0.49</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£89.67 to £179.34</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="7" colspan="1" style="text-align:left;vertical-align:top;">Class II (beta-blockers)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acebutolol (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4g to 1.2 g daily in 2–3 divided doses.</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.67 to £2</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£242.73 to £728.18</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atenolol (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50mg to 100mg daily</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.02 to £0.05</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8.21 to £16.43</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bisoprolol fumarate (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5mg to 10mg od</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.02 to £0.04</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7.69 to £15.38</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esmolol hydrochloride (IV)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50–200  micrograms/kg/minute</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4 hd_h_niceng196er13.tab18_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Cost per infusion bag: £89.69<sup>(b)</sup></td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Metoprolol tartare (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50 mg bd to 300mg daily.</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.10</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.08 to £34.81</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nadolol (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">160mg od</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.43</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£156.43</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Propranolol (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10–40 mg 3–4 times a day</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13 to £0.14</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£49.01 to £52.40</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class II & III (beta blockers/K+ channel blocker)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sotalol hydrochloride (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80 mg to 320 mg daily in 2 divided doses</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.08 to £0.28</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£28.94 to £102.98</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="4" colspan="1" style="text-align:left;vertical-align:top;">Class III (K+ channel blocker)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiodarone (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">200mg od</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.12</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£42.50</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiodarone (IV infusion)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Maximum 1.2 g per day</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£5.87</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dronedarone (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">400mg bd</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2.25</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£821.25</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vernakalant (IV infusion)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Maximum 565 mg per day</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£327.70 per day</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="3" colspan="1" style="text-align:left;vertical-align:top;">Class IV (calcium channel blocker)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diltiazem hydrochloride</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">120mg to 360mg daily</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13 to £0.38</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£46.60 to £139.81</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Verapamil hydrochloride (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40mg to 120 mg tid</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.14</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.34 to £52.40</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Verapamil hydrochloride (slow IV injection)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5–10 mg to be given over 2 minutes</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2.16 to £4.33</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_niceng196er13.tab18_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class V (Positive ionotropic drug)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Digoxin (tablet)</td><td headers="hd_h_niceng196er13.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">125–250 micrograms daily</td><td headers="hd_h_niceng196er13.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.11</td><td headers="hd_h_niceng196er13.tab18_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.34 to £40.67</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng196er13.tab18_1"><p class="no_margin">Source of cost and dose: BNF<a class="bibr" href="#niceng196er13.ref7" rid="niceng196er13.ref7"><sup>7</sup></a>, last accessed January 2020. With exception of diltiazem hydrochloride as this is an unlicensed indication. GC expert advice provided for dosage.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng196er13.tab18_2"><p class="no_margin">Breviblocpre mixed 2.5mg/250ml infusion bags</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: bd: twice daily; IV: intravenous; N/A: not applicable; od: once daily; tid: three times daily.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab19"><div id="niceng196er13.tab19" class="table"><h3><span class="label">Table 19</span><span class="title">Elective inpatient excess bed days cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab19/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab19_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26A</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">272</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£312</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26B</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">157</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£312</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26C</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£325</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27A</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£352</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27B</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">110</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£377</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27C</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£311</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28A</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">381</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£304</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28B</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">196</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£393</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28C</td><td headers="hd_h_niceng196er13.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">198</td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£276</td></tr><tr><td headers="hd_h_niceng196er13.tab19_1_1_1_1 hd_h_niceng196er13.tab19_1_1_1_2 hd_h_niceng196er13.tab19_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er13.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£322</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017–2018<a class="bibr" href="#niceng196er13.ref22" rid="niceng196er13.ref22"><sup>22</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er13tab20"><div id="niceng196er13.tab20" class="table"><h3><span class="label">Table 20</span><span class="title">Non-elective inpatient excess bed days cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571341/table/niceng196er13.tab20/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er13.tab20_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26A</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">422</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£346</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26B</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">135</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£411</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26C</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£264</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27A</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">217</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£331</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27B</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">81</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£297</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27C</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">132</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£311</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28A</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">549</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£254</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28B</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 5–9</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">679</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£303</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28C</td><td headers="hd_h_niceng196er13.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 0–4</td><td headers="hd_h_niceng196er13.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">362</td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£385</td></tr><tr><td headers="hd_h_niceng196er13.tab20_1_1_1_1 hd_h_niceng196er13.tab20_1_1_1_2 hd_h_niceng196er13.tab20_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er13.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£318</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017–2018<a class="bibr" href="#niceng196er13.ref22" rid="niceng196er13.ref22"><sup>22</sup></a></p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal106 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|