Ep. Gerstenfeld et al., Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery, J AM COL C, 33(7), 1999, pp. 1981-1988
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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
.