title: Effectiveness of bi-atrial pacing for reducing atrial fibrillation after coronary artery bypass graft surgery.
abstract: Atrial fibrillation (AF) is common after cardiac surgery and adds significant cost and morbidity. The use of prophylactic pacing strategies to prevent post-operative AF has been controversial. We previously performed a pilot study which suggested that the combination of beta-blockers and bi-atrial pacing (BAP) may reduce AF after cardiac surgery. We prospectively randomized 118 patients to continuous BAP for up to 96 hours post-operatively versus standard therapy. All patients were treated with beta-blockers as tolerated. Patients were paced in the AAI mode at a rate of 100 pulses per minute. The primary endpoint of the study was the occurrence of sustained AF (>10 minutes). There was a significant reduction in the incidence of AF in the BAP group among patients undergoing coronary artery bypass graft surgery with or without aortic valve replacement (35 % vs. 19 % AF; OR=0.38, 95 % CI 0.15, 0.93; p <0.05). Including patients undergoing isolated aortic valve surgery (n=7), there remained a strong trend toward a reduction of AF with pacing (no atrial pacing [NAP] vs. BAP; 35 % vs. 21 % AF; OR=0.48, 95 % CI 0.21, 1.11; p=0.08). Patients age 70 or greater benefited most from pacing (NAP vs. BAP; 55 vs. 25 % AF; p<0.05), while those less than 70 years of age did not (17 vs. 18 % p=NS). There was a significant reduction in the amount of time spent in the intensive care unit among patients receiving BAP (50+/-40 vs. 37+/-25 h; p<0.05).BAP together with beta-blockade after coronary artery bypass graft surgery reduces the incidence of post-operative atrial AF. Elderly patients (age 70 or greater) appear to benefit most, and may be a group to whom this therapy should be targeted.
authors.affiliation: Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA. edwardge@mail.upenn.edu
authors.forename: E P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: M
authors.initials: M
authors.lastname: Khoo
authors.forename: R C
authors.initials: RC
authors.lastname: Martin
authors.forename: J R
authors.initials: JR
authors.lastname: Cook
authors.forename: R
authors.initials: R
authors.lastname: Lancey
authors.forename: K
authors.initials: K
authors.lastname: Rofino
authors.forename: T J
authors.initials: TJ
authors.lastname: Vander Salm
authors.forename: R S
authors.initials: RS
authors.lastname: Mittleman
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D016896:Treatment Outcome