Suppression of Atrial Fibrillation after Coronary Artery Bypass Surgery through Temporary Atrial Epicardial Pacing

Background: Atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) constitutes the most common arrhythmia and results in morbidity and prolonged hospitalization secondary to hemodynamic decompensation. Although pharmacologic therapy has been used to help prevent postoperative atrial fibrillation, it suffers from limited efficacy and adverse effects. In the non operative setting, novel pacing strategies have been shown to reduce recurrences of atrial fibrillation and prolong arrhythmia-free periods in patients with paroxysmal atrial arrhythmias. Aim of the Study: Was to assess the role of different modalities of temporary epicardial pacing for postoperative AF prophylaxis. Methods and Results: From November 2004 to March 2006, in Cairo University Hospitals (old and new hospital) 75 patients without structural heart disease and who underwent CABG were randomly classified into one of the following 3 groups: Biatrial pacing (BAP), Right atrial pacing (LAP) and no pacing (control). Pacing was performed for 5 days immediately Post-CABG. Atrial fibrillation was significantly reduced in BAP group compared to RAP and control group (BAP, 16%; RAP, 28%; control, 44%; p=0.04 and 0.02 respectively). The mean length of stay in the intensive care unit (LOS ICU) and in the hospital (LOSHOS) were also significantly reduced in the BAP pacing group (2.8 ±0.7 versus 4.6±4.5 days in control group; p=0.04, and 4.2±3.2 days in RAP pacing group; p=0.01) and (6.1 ± 1.2 versus 9.0±4.1 days in the control groups; p=0.002 and 8.7± 1.3 days in RAP pacing groups; p=0.01) respectively. Conclusions: Simultaneous right and left atrial pacing is well tolerated and is more effective in preventing post-CABG AF than single-site pacing and results in a shortened hospital stay. Identifying patients at risk for developing postoperative AF and using this prophylactic method may be the optimal effective strategy.