CLINICAL STUDIES
Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery
Edward P. Gerstenfeld, MS, MD*,
Michael R. S. Hill, PhD ,
Steven N. French, PhD,
Rahul Mehra, PhD,
Karen Rofino, RN*,
Thomas J. Vander Salm, MD* and
Robert S. Mittleman, MD, FACC*
* Department of Medicine and Department of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
Medtronic, Inc., Minneapolis, Minnesota, USA
Manuscript received September 10, 1998;
revised manuscript received January 12, 1999,
accepted February 10, 1999.
Reprint requests and correspondence: Dr. Robert S. Mittleman, Cardiovascular Division, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, Massachusetts 01655
rmittlem{at}umassmed.ummed.edu
OBJECTIVES
The purpose of this study was to determine if atrial pacing is effective 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. Atrial-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 groups: no 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 patients were monitored with Holter monitors or full disclosure telemetry to identify the onset of AF. The primary end point of the study was the first onset of sustained AF.
RESULTS
There was no significant difference in the proportion of patients developing 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 after 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 setting is safe and well tolerated. We did not find that post-CABG pacing prevented AF in this pilot study; however, the role of combined pacing and beta-blockade merits further study.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | APB | = atrial premature beat | | AV | = atrioventricular | | BAP | = biatrial pacing | | CABG | = coronary artery bypass graft | | CI | = confidence interval | | MI | = myocardial infarction | | NAP | = no atrial pacing | | OR | = odds ratio | | ppm | = pulses per minute | | RAP | = right atrial pacing | | UMMC | = University of Massachusetts Medical Center |
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