Meta-analysis of randomized trials on the efficacy of posterior pericardiotomy in preventing atrial fibrillation after coronary artery bypass surgery.
OBJECTIVE
Posterior pericardiotomy is considered a method to reduce the incidence of atrial fibrillation after cardiac surgery. Its efficacy in preventing atrial fibrillation and supraventricular arrhythmias after coronary artery bypass surgery has been evaluated in the present meta-analysis.


METHODS
This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews.


RESULTS
The search yielded 6 prospective, randomized studies reporting on postoperative atrial fibrillation in 763 patients after coronary artery bypass grafting. The cumulative incidence of atrial fibrillation was 10.8% in the posterior pericardiotomy group (PP group) and 28.1% in the control group (I(2) 68%, random effect: P = .003; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.16-0.69). Supraventricular arrhythmias occurred in 13.8% of patients in the PP group and 35.4% in the control group (I(2) 70%, random effect: P = .002; OR, 0.31; 95% CI, 0.15-0.65). Early pericardial effusion (6.9% vs 46.2%; I(2) 67%; random effect: P < .0001; OR, 0.10; 95% CI, 0.04-0.28) and late pericardial effusion (0% vs 11.3%; I(2) 0%; fixed effect: P = .0001; OR, 0.04; 95% CI, 0.01-0.21) were significantly less frequent in the PP group. Pleural effusion (5 studies included: 22.2% vs 17.1%; I(2) 0%; fixed effect: P = .10; OR, 1.40; 95% CI, 0.94-2.08) and pulmonary complications were only slightly more frequent in the PP group (4 studies included: 3.6% vs 2.5%; I(2) 0%; fixed effect: P = .46; OR, 1.45; 95% CI, 0.54-3.86).


CONCLUSIONS
Posterior pericardiotomy seems to significantly reduce the incidence of postoperative atrial fibrillation and supraventricular arrhythmias after coronary artery bypass grafting. The marked reduction of postoperative pericardial effusion after posterior pericardiotomy suggests that pericardial effusion is one of the main triggers involved in the development of atrial fibrillation after cardiac surgery.
Biancari
Fausto
F
Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
Mahar
Muhammad Ali Asim
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010492:Pericardiectomy / Q000009:adverse effects; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome