Table 1.
Patient and Operative Characteristics*
| PPM (N = 35) |
No PPM (N = 208) |
Total (N = 243) |
P Value** | |
|---|---|---|---|---|
| Age, years | 70 ± 9.2 | 68.9 ± 10.5 | 69.1 ± 10.3 | 0.56 |
| Female sex | 18 (51.4) | 96 (46.2) | 114 (46.9) | 0.56 |
| Congestive Heart Failure | 16 (45.7) | 97 (46.6) | 113 (46.5) | 0.92 |
| Hypertension | 28 (80.0) | 164 (78.8) | 192 (79.0) | 0.88 |
| Diabetes | 9 (25.7) | 47 (22.6) | 56 (23.0) | 0.69 |
| Previous stroke or TIA | 5 (14.3) | 20 (9.6) | 25 (10.3) | 0.38 |
| Vascular disease† | 11(31.4) | 29 (13.9) | 40 (16.5) | 0.01 |
| CHA2DS2-VASc score | 3.7 ± 1.6 | 3.3 ± 1.6 | 3.4 ± 1.6 | 0.16 |
| Previous cardiac surgery | 5 (14.3) | 21 (10.1) | 26 (10.7) | 0.55 |
| Beta blockers at baseline | 23 (65.7) | 137 (65.9) | 160 (65.8) | 0.99 |
| Amiodarone at baseline | 1 (2.9) | 15 (7.2) | 16 (6.6) | 0.48 |
| NYHA Class III/IV | 23/35 (65.7) | 85/207(41.1) | 108/242 (44.6) | 0.01 |
| Atrial Fibrillation | 0.92 | |||
| Long-standing persistent | 19 (54.3) | 111 (53.4) | 130 (53.5) | |
| Persistent | 16 (45.7) | 97 (46.6) | 113 (46.5) | |
| Cause of mitral-valve disease | 0.24 | |||
| Organic primary MR | 17 (48.6) | 123 (59.1) | 140 (57.6) | |
| Functional, non-ischemic MR | 13 (37.1) | 71 (34.1) | 84 (34.6) | |
| Functional, ischemic MR | 5 (14.3) | 14 (6.7) | 19 (7.8) | |
| Left ventricular ejection fraction, % | 54.7 ± 7.2 | 56.3 ± 7.5 | 56.0 ± 7.5 | 0.30 |
| Preoperative AF (assessed by EKG)‡ | 31/34 (91.2) | 189/208 (90.9) | 220/242 (90.9) | >0.99 |
| Randomization Assignment | 0.01 | |||
| MVS alone | 9 (25.7) | 108 (51.9) | 117(48.1) | |
| MVS + PVI | 10 (28.6) | 52 (25.0) | 62 (25.5) | |
| MVS + Biatrial maze | 16 (45.7) | 48 (23.1) | 64 (26.3) | |
| Mitral-valve surgery§ | 0.05 | |||
| Valve replacement | 21/35 (60.0) | 87/207 (42.0) | 108/242 (44.6) | |
| Valve repair | 14/35 (40.0) | 120/207 (58.0) | 134/242 (55.4) | |
| Concomitant procedure§ | ||||
| Tricuspid valve surgery | 21/35 (60.0) | 71/207 (34.3) | 92/242 (38.0) | 0.004 |
| Aortic valve surgery | 4/35 (11.4) | 27/207 (13.0) | 31/242 (12.8) | >0.99 |
| CABG | 9/35 (25.7) | 38/207 (18.4) | 47/242 (19.4) | 0.31 |
| Other | 7/35 (20.0) | 18/207(8.7) | 25/242 (10.3) | 0.07 |
| Cardiopulmonary bypass time, min | 142.6 ± 56.5 | 140.4 ± 58.8 | 140.7 ± 58.4 | 0.84 |
| Aortic cross-clamp time, min | 99.9 ± 36.8 | 95.2 ± 43.5 | 95.8 ± 42.6 | 0.55 |
Abbreviations: AF, Atrial fibrillation; CABG, coronary artery bypass graft; CHA2DS2-VASc score, Congestive heart failure, Hypertension, Age (≥75=2 points), Diabetes mellitus, prior Stroke or transient ischemic attack (2 points), Vascular disease (peripheral arterial disease, previous myocardial infarction, aortic atheroma), Age (65–74=1 point) and Sex category (female gender); EKG, electrocardiogram; MR, mitral regurgitation; MVS, mitral-valve surgery, NYHA, New York Heart Association; PPM, permanent pacemaker; PVI, pulmonary-vein isolation; TIA, transient ischemic attack
Plus-minus values are means ± SD, categorical values are n (%)
P values based on two independent sample t-test for continuous variables and chi-squared test or Fisher’s exact test for categorical variables
Vascular disease defined as presence of peripheral vascular disease or history of myocardial infarction
To be eligible for study, must have AF documented by direct EKG upon arrival in OR or within 6 months prior to randomization
One patient withdrew consent before index surgery