Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis.
BACKGROUND
Recent studies have reported the use of temporary epicardial atrial pacing as prophylaxis for postoperative atrial fibrillation (AF). The aim of this study was to assess the effect of pacing therapies for prevention of postoperative AF using meta-analysis.


RESULTS
Using a computerized MEDLINE search, eight pacing prophylaxis trials with 776 patients were included in the meta-analysis. Trials compared control patients to patients randomized to right atrial, left atrial, or biatrial pacing used in conjunction with either fixed high-rate pacing or overdrive pacing. Overdrive biatrial pacing (OR 2.6, CI 1.4-4.8), overdrive right atrial pacing (OR 1.8, CI 1.1-2.7), and fixed high-rate biatrial pacing (OR 2.5, CI 1.3-5.1) demonstrated a significant antiarrhythmic effect for prevention of AF after open heart surgery. Furthermore, studies investigating overdrive left atrial pacing and fixed high-rate right atrial pacing have been underpowered to assess efficacy.


CONCLUSIONS
Biatrial overdrive and fixed high-rate pacing and right atrial fixed high-rate pacing reduced the risk of new-onset AF after open heart surgery, and the relative risk reduction is approximately 2.5-fold. These results imply that various pacing algorithms are useful as a nonpharmacologic method to prevent postoperative AF.
Daoud
Emile G
EG
MidOhio Cardiology and Vascular Consultants, MidWest Research Foundation, and Riverside-Methodist Hospital, Columbus, Ohio, USA. egd@mocc.cc
Snow
Rick
R
Hummel
John D
JD
Kalbfleisch
Steven J
SJ
Weiss
Raul
R
Augostini
Ralph
R
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000145:classification / Q000379:methods* / Q000706:statistics & numerical data*; D006325:Heart Atria; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013903:Thoracic Surgery / Q000145:classification / Q000706:statistics & numerical data*; D016896:Treatment Outcome