(Circulation. 2000;102:755.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Biatrial Pacing in Prevention of Postoperative Atrial Fibrillation After Coronary Artery Bypass Surgery
From the Cardiac Medical Unit (K.F.) and the Cardiothroacic Surgical Unit (C.S.W.C., J.W.T.L., G.W.H., D.C., M.P.S.), Grantham Hospital and the Division of Cardiology, Queen Mary Hospital (K.L.L., C.P.L.), Hong Kong, China.
Correspondence to Dr Katherine Fan, Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong, China. E-mail fankatherine{at}hotmail.com
Background—Atrial fibrillation (AF) is common after coronary artery bypass surgery (CABG) and results in prolonged hospitalization. The purpose of this study was to evaluate the efficacy of biatrial pacing in preventing post-CABG AF compared with single-site atrial pacing.
Methods and Results—A total of 132 patients who had no history of AF and who underwent CABG were randomized to 1 of the following 4 groups: biatrial pacing (BiA), left atrial pacing (LA), right atrial pacing (RA), or no pacing (control) in postoperative period. Overdrive atrial pacing was performed for 5 days. The incidence of AF was significantly reduced in the BiA group (12.5%) compared with the other 3 groups (LA, 36.4%; RA, 33.3%; control, 41.9%; P<0.05). The mean length of hospital stay was significantly reduced in the BiA group. At baseline, the mean P-wave duration (Pdur) and dispersion (Pdis) were not prolonged. BiA pacing resulted in the most significant percentage of reduction in Pdis when compared with the LA or RA groups (BiA, 42±8%; LA, 13±6%; RA, 10±9%; P<0.05 for BiA versus LA or RA). No significant differences existed in mean Pdur and Pdis between patients who developed AF and those who remained in sinus rhythm at baseline. However, only those patients who remained in sinus rhythm had a significant reduction in mean Pdur and Pdis after pacing therapy.
Conclusions—Biatrial overdrive pacing is more effective in preventing post-CABG AF than single-site atrial pacing; this therapy also results in a shortened hospital stay. The overall reduction in atrial activation time with BiA pacing was reflected in the reduction in Pdis.
Key Words: arrhythmia • electrocardiography • pacing • surgery
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