Biatrial Pacing to Prevent Atrial Fibrillation after Coronary Artery Bypass

Wing-Kuk Au; Shiu-Wah Chiu; Man-Ping Sun; Lik-Ching Cheung; Lik‐Cheung Cheng

doi:10.1177/021849230301100309

September 1, 2003Asian Cardiovascular and Thoracic Annals

Biatrial Pacing to Prevent Atrial Fibrillation after Coronary Artery Bypass

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Why the study?

Does continuous overdrive biatrial pacing prevent atrial fibrillation in patients undergoing coronary artery bypass surgery?

Structured PICO

Does continuous overdrive biatrial pacing prevent atrial fibrillation in patients undergoing coronary artery bypass surgery?

P

Population

104 patients undergoing coronary artery bypass surgery (52 patients selected for pacing, including 37 males, and 52 matched control patients).

I

Intervention

Continuous overdrive biatrial pacing (AAI mode at 90 pulses per minute or 10 pulses above underlying rate, maximum < 140/min) for 3 days via pacing wires attached to the right atrial appendage and roof of the left atrium.

C

Comparator

Matched control group of 52 patients.

O

Outcome

Onset of atrial fibrillation during hospital stay.hard clinical

Continuous overdrive biatrial pacing after coronary artery bypass surgery is safe but does not reduce the incidence of postoperative atrial fibrillation.

Implication

Does not support routine biatrial pacing post-CABG; leaves open efficacy in randomized trials.

Abstract

Between October 1999 and December 2000, 52 patients (37 male) undergoing coronary artery bypass surgery were selected for overdrive biatrial pacing to determine its effectiveness in reducing atrial fibrillation. A pacing wire was attached to the right atrial appendage and another to the roof of the left atrium behind the aorta. The atria were paced continuously in AAI mode at a rate of 90 pulses per minute or 10 pulses above the underlying rate (maximum rate < 140/min) for 3 days. The endpoint was the onset of atrial fibrillation during hospital stay. Results were compared with those of a control group of 52 matched patients. There were no significant differences in the occurrence of atrial fibrillation (30% in the paced group vs. 25% in the control group), morbidity, or length of hospital stay. Continuous biatrial pacing after coronary bypass surgery was safe and well tolerated, however, it did not prevent or lower the incidence of atrial fibrillation.