Temporary atrial pacing in the prevention of postoperative atrial fibrillation.
BACKGROUND
Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). Since its prevention with prophylactic drug therapy has limited success, alternative approaches are desirable. This study examined the efficacy of atrial or biatrial pacing, compared with no pacing, on the incidence of AF after isolated CABG.


METHODS
From August 2002 to September 2004, 240 patients underwent CABG. After surgery, right and left atrial epicardial pacing wires were implanted for 72 hours of temporary pacing. Patients were randomly assigned to one of three groups: no pacing (control group), right atrial (RA), and biatrial (BiA) pacing. Cardiac rhythm was monitored continuously during intensive care, or daily on the ward. The primary endpoints of this study were an episode of AF occurring up to 72 hours after CABG and the risk factors correlated with this event.


RESULTS
Atrial and BiA pacing significantly lowered the incidence (1.25% vs 25%, P = 0.001) of AF episodes, and were both correlated (odd ratio 0.038; 95% confidence interval 0.005-0.29) with a decrease in rates of postoperative AF. Multivariable analysis identified older age (odd ratio 1.074; 95% confidence interval 1.024-1.12) and no pacing as independent risk factors of postoperative AF.


CONCLUSIONS
Temporary right atrial or biatrial pacing after CABG significantly decreased the postoperative incidence of AF. Multivariable analysis identified older age and no pacing as predictors of AF occurrence.
Neto
Vicente Avila
VA
Real e Benemérita Associação Portuguesa de Beneficência, Brazil. vicavilaneto@terra.com.br
Costa
Roberto
R
Da Silva
Kátia Regina
KR
Martins
André Luiz Mendes
AL
Escobar
Luiz Fernando
LF
Moreira
Luiz Felipe Pinho
LF
Costa
Regina Valéria
RV
Santos
Letícia Bezerra
LB
Melo
Ricardo Fernandes Azevedo
RF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012307:Risk Factors; D016896:Treatment Outcome