title: Postoperative atrial fibrillation is not pulmonary vein dependent: results from a randomized trial.
abstract: BACKGROUND
  Although often short-lived and self-limiting, postoperative atrial fibrillation (POAF) is a well-recognized postoperative complication of cardiac surgery and is associated with a 2-fold increase in cardiovascular mortality and morbidity.
  
  
  OBJECTIVE
  Our aim was to determine whether intraoperative bilateral pulmonary vein radiofrequency ablation decreases the incidence of POAF in patients undergoing coronary artery bypass grafting (CABG).
  
  
  METHODS
  A total of 175 patients undergoing CABG was prospectively randomized to undergo adjuvant bilateral radiofrequency pulmonary vein ablation in addition to CABG (group A; n = 89) or CABG alone (group B; n = 86). Intraoperative pulmonary vein isolation was confirmed by the inability to pace the heart via the pulmonary veins after ablation. All patients received postoperative β-blocker.
  
  
  RESULTS
  There was no difference in the incidence of POAF in the treatment group who underwent adjuvant pulmonary vein ablation (group A; 37.1%) compared with the control group who did not (group B; 36.1%) (P = .887). There were no differences in postoperative inotropic support, antiarrhythmic drug use, need for oral anticoagulation, and complication rates. The mean length of postoperative hospital stay was 8.2 ± 6.5 days in the ablation group and 6.7 ± 4.6 days in the control group (P < .001).
  
  
  CONCLUSIONS
  Adjuvant pulmonary vein isolation does not decrease the incidence of POAF or its clinical impact but increases the mean length of stay in the hospital. The mechanism of POAF does not appear to depend on the pulmonary veins.
authors.affiliation: Departments of Surgery. Electronic address: bob.kiaii@lhsc.on.ca.
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.affiliation: Departments of Surgery.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fox
authors.affiliation: Departments of Surgery.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Chase
authors.affiliation: Departments of Surgery.
authors.forename: Michaela
authors.initials: M
authors.lastname: Fernandes
authors.affiliation: Biostatistics.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Stitt
authors.affiliation: Departments of Surgery.
authors.forename: Ray
authors.initials: R
authors.lastname: Guo
authors.affiliation: Departments of Surgery.
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Quantz
authors.affiliation: Departments of Surgery.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Departments of Surgery.
authors.forename: Pavan
authors.initials: P
authors.lastname: Koka
authors.affiliation: Departments of Surgery.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClure
authors.affiliation: Departments of Surgery.
authors.forename: F Neil
authors.initials: FN
authors.lastname: McKenzie
authors.affiliation: Biostatistics.
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.affiliation: Departments of Surgery.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.affiliation: Medicine, Western University, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Skanes
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002170:Canada; D017115:Catheter Ablation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011667:Pulmonary Veins / Q000601:surgery*
keywords: Ablation; Atrial fibrillation; Bypass; Electrophysiology; Surgery