title: Continuous biatrial pacing to prevent early recurrence of atrial fibrillation after the Maze procedure.
abstract: OBJECTIVE
  It has been suggested that overdrive biatrial pacing may prevent the recurrence of atrial fibrillation after the Maze procedure. To further evaluate this hypothesis, we performed a randomized prospective study in 100 patients undergoing valve surgery concomitant with a full Maze procedure to determine the effectiveness of biatrial pacing in the postoperative period to reduce early recurrence of atrial fibrillation.
  
  
  METHODS
  Between January 2002 and December 2008, 100 patients undergoing mitral valve ± tricuspid valve surgery concomitant with the Maze procedure were randomized into 2 equal groups: the study group using overdrive biatrial pacing and a control group without pacing. One pacing wire was attached to the crista terminalis area of the right atrium, and the other pacing wire was attached to the Bachmann's bundle area located in the roof of the left atrium. The atria were paced continuously in AAI mode at a rate of 80 pulses per minute or 10 pulses above the underlying rate for 5 days. The end points were the onset of recurrent atrial fibrillation or discharge.
  
  
  RESULTS
  The incidence of recurrent postoperative atrial fibrillation was significantly less in the study group, with 6 of 50 patients (12%) incurring atrial fibrillation compared with 18 of 50 patients (36%) in the control group (P < .01). The length of hospital stay was significantly reduced in the study group (P < .01), and the mean costs of hospital stay were significantly lower in the control group (P < .05).
  
  
  CONCLUSIONS
  Biatrial overdrive pacing is well tolerated and more effective in preventing the early recurrence of atrial fibrillation after the Maze procedure. This therapy also results in shortened hospital stays and decreased hospital costs. However, the impacts of the long-term results in the Maze procedure require further study.
authors.affiliation: Scripps Memorial Hospital, La Jolla, Calif, USA. wangmd100@gmail.com
authors.forename: William
authors.initials: W
authors.lastname: Wang
authors.forename: Donald
authors.initials: D
authors.lastname: Buehler
authors.forename: Xiao Dong
authors.initials: XD
authors.lastname: Feng
authors.forename: Shui Ye
authors.initials: SY
authors.lastname: Zhang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D016275:Atrial Function; D002304:Cardiac Pacing, Artificial / Q000191:economics; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics; D016009:Chi-Square Distribution; D002681:China; D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome