Prevention of atrial fibrillation after cardiac valvular surgery by epicardial, biatrial synchronous pacing

Marianne Debrunner; Barbara Naegeli; Michele Genoni; Marko Turina; Osmund Bertel

doi:10.1016/s1010-7940(03)00644-4

December 13, 2003European Journal of Cardio-Thoracic SurgeryOpen Access

Prevention of atrial fibrillation after cardiac valvular surgery by epicardial, biatrial synchronous pacing

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Why the study?

Does biatrial synchronous pacing reduce postoperative atrial fibrillation in patients undergoing cardiac valvular surgery?

Structured PICO

Does biatrial synchronous pacing reduce postoperative atrial fibrillation in patients undergoing cardiac valvular surgery?

P

Population

80 patients undergoing cardiac valvular surgery (n=80), mean age 66 +/- 10 years, 52 men.

I

Intervention

Biatrial synchronous pacing (BAP) for 72 hours postoperatively, continuously paced at a rate of 10 beats per minute higher than the intrinsic rate starting immediately after surgery.

C

Comparator

No atrial pacing (controls). Both groups had one pair of epicardial wires attached to the right atrium.

O

Outcome

Onset of atrial fibrillation (AF) within the first 3 days postoperatively, monitored with full disclosure telemetry or Holter monitors.

Temporary biatrial synchronous pacing for 72 hours postoperatively significantly reduces the incidence of atrial fibrillation after cardiac valvular surgery.

Implication

Supports temporary biatrial pacing after valvular surgery; extends RCT evidence for postoperative AF prevention.

Abstract

OBJECTIVE: Postoperative atrial fibrillation (AF) after cardiac surgery is a frequent complication after valvular surgery (30-60%). The purpose of this prospective, randomized study was to determine if biatrial synchronous pacing reduces postoperative AF after cardiac valvular surgery as compared to conventional therapy. METHODS: Eighty patients subjected to valvular surgery (52 men, age 66 +/- 10 years) were randomized to one of two groups: one group was treated with biatrial, synchronous pacing (BAP) for 72 h postoperatively (n=40) the other group received no atrial pacing (controls; n=40). All patients had one pair of epicardial wires attached to the right atrium. An additional electrode was placed to the left atrium in the BAP group. These patients were continuously paced at a rate of 10 beats per minute higher than the intrinsic rate starting immediately after surgery. All patients were monitored with full disclosure telemetry or Holter monitors to identify onset of AF. RESULTS: Eighteen of the 40 patients in the control group (45%) developed AF within the first 3 days postoperatively as compared to eight patients (20%) in the BAP group (P=0.02). No complications occurred associated with the placement, maintenance and removal of the atrial pacing electrodes. CONCLUSIONS: Temporary, biatrial synchronous pacing during the first 3 postoperative days is safe and has a significant rhythm-stabilizing effect in patients undergoing valvular cardiac surgery.