Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery

OBJECTIVES The purpose of this study was to determine if atrial pacing is e ffective in reducing postoperative atrial fibrillation (AF). BACKGROUND Atrial fibrillation after coronary artery bypass grafting (CABG) is a common problem for which medical management has been disappointing At rial-based pacing has become an attractive nonpharmacologic therapy for the prevention of AF. METHODS Sixty-one post-CABG patients (mean age = 65 years) were randomized to one of three atrial pacing (NAP), right atrial pacing (RAP) or biatrial pacing (BAP). Each patient had one set of atrial wires attached to both the right and left atria, respectively, at the conclusion of surgery. Patients in the RAP and BAP groups were continuously paced at a rate of 100 pulses per minute for 96 h or until the onset of sustained AF (>10 min). All patie nts were monitored with Holter monitors or full disclosure telemetry to ide ntify the onset of AF. The primary end point of the study was the first ons et of sustained,AF RESULTS There was no significant difference in the proportion of patients d eveloping AF in the three groups (NAP = 33%; RAP = 29%; BAP = 37%; p > 0.7) . However, for the subset of patients on beta-adrenergic blocking agents af ter CABG, there was a trend toward less AF in the paced groups. There were no serious complications related to pacing, although in three patients the pacemaker appeared to induce AF by pacing during atrial repolarization. CONCLUSIONS Continuous right or biatrial pacing in the postoperative settin g is safe and well tolerated. We did not find that post-CABG pacing prevent ed AF in this pilot study; however, the role of combined pacing and beta-bl ockade merits further study. (C) 1999 by the American College of Cardiology .