Randomized, double-blind trial of simultaneous right and left atrial epicardial pacing for prevention of post-open heart surgery atrial fibrillation.
BACKGROUND
The purpose of this study was to assess simultaneous right and left atrial pacing as prophylaxis for postoperative atrial fibrillation.


RESULTS
In a double-blind, randomized fashion, 118 patients who underwent open heart surgery were assigned to right atrial pacing at 45 bpm (RA-AAI; n=39), right atrial triggered pacing at a rate of >/=85 bpm (RA-AAT; n=38), or simultaneous right and left atrial triggered pacing at a rate of >/=85 bpm (Bi-AAT; n=41). Holter monitoring was performed for 4. 8+/-1.4 days after surgery to assess for episodes of atrial fibrillation lasting >5 minutes. The prevalence of postoperative atrial fibrillation was significantly less in the patients randomized to biatrial AAT pacing when compared with the other 2 pacing regimens (P=0.02). An episode of atrial fibrillation occurred in 4 (10%) of 41 patients in the Bi-AAT group compared with 11 (28%) of 39 patients in the RA-AAI group (P=0.03 versus Bi-AAT) and 12 (32%) of 38 patients in the RA-AAT group (P=0.01 versus Bi-AAT). There was no difference in the occurrence of atrial fibrillation between the right atrial AAI and AAT groups (P=0.8). There was no significant difference among the 3 groups with regard to the number of postoperative hospital days (7.3+/-4.2 days), morbidity (5.1%), or mortality rate (2.5%).


CONCLUSIONS
Simultaneous right and left atrial triggered pacing is well tolerated and significantly reduces the prevalence of post-open heart surgery atrial fibrillation.
Daoud
E G
EG
Divisions of Cardiology, University of Michigan Medical Center, Ann Arbor, MI, USA. egd@mocc.cc
Dabir
R
R
Archambeau
M
M
Morady
F
F
Strickberger
S A
SA
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000503:physiopathology; D006325:Heart Atria; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*