Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation.
OBJECTIVE
Post-operative atrial fibrillation (POAF) is a common complication after cardiac surgery and often leads to poorly tolerated fast ventricular rates. Negative dromotropic drugs are not always effective and may not be well tolerated in heart failure patients. Aim of this study is to verify if high-frequency stimulation of the right inferior fat pad (RIFPS) allows an effective decrease in ventricular rate (VR) during POAF.


METHODS
We enrolled 32 consecutive patients submitted to bypass; during surgery, a temporary heart wire was implanted in a site where RIFPS evoked a functional AV block. During POAF, RIFPS was delivered from the heart wire to decrease VR.


RESULTS
Intra-operative RIFPS evoked complete AV block in 29 patients (91%). Fourteen patients (44%) developed POAF (mean VR 127 +/- 12 bpm). In these patients, RIFPS achieved a 25% reduction of VR and complete AV block with 6.0 +/- 1.9 and 7.5 +/- 1.8 V (duration 0.2 ms, frequency 50 Hz), respectively.


CONCLUSIONS
Epicardial RIFPS represents an effective and feasible technique to decrease VR during POAF.
Rossi
Pietro
P
Department of Medicine, Unit of Electrophysiology, Belcolle Hospital, Viterbo, Italy. pietro_rossi2004@yahoo.it
Bianchi
Stefano
S
Barretta
Antonio
A
Della Scala
Alberto
A
Kornet
Lilian
L
De Paulis
Ruggero
R
Bellisario
Alessandro
A
D'Addio
Vittorio
V
Pavaci
Herribert
H
Miraldi
Fabio
F