Abstract
Background: Recently, several temporary multisite pacing methods have been developed for prevention of postoperative atrial fibrillation (AF).
Hypothesis: In this study, we evaluated the effect of triple‐site temporary triggered pacing in the AAT mode on the development of AF in patients undergoing coronary artery bypass graft (CABG) at high risk for developing postoperative AF.
Methods: A total of 70 patients undergoing CABG were randomly assigned either to pacing group (study group, n=35 patients) or to no pacing group (control group, n=35 patients). The external pacemaker was programmed to pace at the atrial triggered mode at a lower rate of 40 beats/min for 4 days.
Results: Atrial fibrillation, defined as lasting > 30 s, occurred in 4 patients (11.4%) in the study group and in 16 patients (45.7%) in the control group (p = 0.003). Sustained AF, defined as AF lasting > 10 min, also was observed less frequently in the study group than in the control group (11.6 vs. 37.1%, p = 0.024). Triple‐site triggered atrial pacing was observed to reduce the incidence of AF by 75% and the incidence of sustained AF by 69%.
Conclusions: We believe that multiple‐site temporary pacing in the triggered mode is an effective way of preventing postoperative AF. This technique may be used especially in patients at high risk of developing AF.
Keywords: atrial fibrillation, coronary artery bypass surgery, pacing
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References
- 1. Rubin DA, Nieminski KE, Reed GE, Herman MV: Predictors, prevention, and long‐term prognosis of atrial fibrillation after coronary artery bypass graft operations. J Thorac Cardiovasc Surg 1987; 94: 331–335 [PubMed] [Google Scholar]
- 2. Fuller JA, Adams GG, Buxton B: Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg 1989; 97: 821–825 [PubMed] [Google Scholar]
- 3. Force T, Hibberd P, Weeks G, Kemper AJ, Bloomfield P, Tow D, Josa M, Khuri S, Parisi AF: Perioperative myocardial infarction after coronary artery bypass surgery. Clinical significance and approach to risk stratification. Circulation 1990; 82: 903–912 [DOI] [PubMed] [Google Scholar]
- 4. Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS: Atrial fibrillation following coronary artery bypass graft surgery: Predictors, outcomes, and resource utilization. Multi Center Study of Perioperative Ischemia Research Group. J Am Med Assoc 1996; 276: 300–306 [PubMed] [Google Scholar]
- 5. Reed GL III, Singer DE, Picard EH, DeSanctis RW: Stroke following coronary‐artery bypass surgery. A case‐control estimate of the risk from carotid bruits. N Engl J Med 1988; 319: 1246–1250 [DOI] [PubMed] [Google Scholar]
- 6. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL: Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993; 56: 539–549 [DOI] [PubMed] [Google Scholar]
- 7. Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammer‐meister KE: Atrial fibrillation after cardiac surgery: A major morbid event? Ann Surg 1997; 226: 501–511 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS: Cost‐effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol 2002; 40: 737–745 [DOI] [PubMed] [Google Scholar]
- 9. Bharucha DB, Kowey PR: Management and prevention of atrial fibrillation after cardiovascular surgery. Am J Cardiol 2000; 85: 20D–24D [DOI] [PubMed] [Google Scholar]
- 10. Daoud EG, Strickberger SA, Man KC, Goyal R, Deeb GM, Bolling SF, Pagani FD, Bitar C, Meissner MD, Morady F: Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 1997; 337: 1785–1791 [DOI] [PubMed] [Google Scholar]
- 11. Gomes JA, Ip J, Santoni‐Rugiu F, Mehta D, Ergin A, Lansman S, Pe E, Newhouse TT, Chao S: Oral d, l sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: A randomized, double‐blind, placebo‐controlled study. J Am Coll Cardiol 1999; 34: 334–339 [DOI] [PubMed] [Google Scholar]
- 12. Guarnieri T, Nolan S, Gottlieb SO, Dudek A, Lowry DR: Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: The Amiodarone Reduction in Coronary Heart (ARCH) trial. J Am Coll Cardiol 1999; 34: 343–347 [DOI] [PubMed] [Google Scholar]
- 13. Connolly SJ, Cybulsky I, Lamy A, Roberts RS, O'Brien B, Carroll S, Crystal E, Thorpe KE, Gent M: Double‐blind, placebo‐controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: The beta‐Blocker Length Of Stay (BLOS) study. Am Heart J 2003; 145: 226–232 [DOI] [PubMed] [Google Scholar]
- 14. Waldo AL: Mechanisms of atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14: S267–S274 [DOI] [PubMed] [Google Scholar]
- 15. Frost L, Christiansen EH, Molgaard H, Jacobsen CJ, Allermand H, Thomsen PE: Premature atrial beat eliciting atrial fibrillation after coronary artery bypass grafting. J Electrocardiol 1995; 28: 297–305 [DOI] [PubMed] [Google Scholar]
- 16. Maisel WH, Rawn JD, Stevenson WG: Atrial fibrillation after cardiac surgery. Ann Intern Med 2001; 135: 1061–1073 [DOI] [PubMed] [Google Scholar]
- 17. Papageorgiou P, Monahan K, Boyle NG, Seifert MJ, Beswick P, Zebede I Epstein LM, Josephson ME: Site‐dependent intraatrial conduction delay. Relationship to initiation of atrial fibrillation. Circulation 1996; 94: 384–38918. [DOI] [PubMed] [Google Scholar]
- 18. Misier AR, Opthof T, van Hemel NM, Defauw JJ, de Bakker JM, Janse MJ, van Capelle FJ: Increased dispersion of “refractoriness” in patients with idiopathic paroxysmal atrial fibrillation. J Am Coll Cardiol 1992; 19: 1531–1535 [DOI] [PubMed] [Google Scholar]
- 19. Daubert C, Gras D, Berder V, Leclercq C, Mabo P: Permanent atrial resynchronization by synchronous bi‐atrial pacing in the preventive treatment of atrial flutter associated with high degree interatrial block. Arch Mal Coeur Vaiss 1994; 87: 1535–1546 [PubMed] [Google Scholar]
- 20. Saksena S, Prakash A, Hill M, Krol RB, Munsif AN, Mathew PP, Mehra R: Prevention of recurrent atrial fibrillation with chronic dual‐site right atrial pacing. J Am Coll Cardiol 1996; 28: 687–694 [DOI] [PubMed] [Google Scholar]
- 21. Delfaut P, Saksena S, Prakash A, KrolR B: Long‐term outcome of patients with drug‐refractory atrial flutter and fibrillation after single‐ and dual‐site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 1998; 32: 1900–1908 [DOI] [PubMed] [Google Scholar]
- 22. Ramdat Misier AR, Beukema WP, Oude Luttikhuis HA, Willems R: Multi‐site atrial pacing: An option for atrial fibrillation prevention? Preliminary results of the Dutch dual‐site right atrial pacing for prevention of atrial fibrillation study. Am J Cardiol 2000; 86: K20–K24 [DOI] [PubMed] [Google Scholar]
- 23. Lau CP, T se HF, Yu CM, Teo WS, Kam R, Ng KS, Huang SS, Lin JL, Fitts SM, Hettrick DA, Hill MR, and the New Indication for Preventive Pacing in Atrial Fibrillation (NIPP‐AF) Investigators : Dual‐site atrial pacing for atrial fibrillation in patients without bradycardia. Am J Cardiol 2001; 88: 371–375 [DOI] [PubMed] [Google Scholar]
- 24. Gerstenfeld EP, Hill MR, French SN, Mehra R, Rofino K, Vander Salm TJ, Mittleman RS: Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol 1999; 33: 1981–1988 [DOI] [PubMed] [Google Scholar]
- 25. Greenberg MD, Katz NM, Iuliano S, Tempesta BJ, Solomon AJ: Atrial pacing for the prevention of atrial fibrillation after cardiovascular surgery. J Am Coll Cardiol 2000; 35: 1416–1422 [DOI] [PubMed] [Google Scholar]
- 26. Fan K, Lee KL, Chiu CS, Lee JW, He GW, Cheung D, Sun MP, Lau CP: Effects of biatrial pacing in prevention of postoperative atrial fibrillation after coronary artery bypass surgery. Circulation 2000; 102: 755–760 [DOI] [PubMed] [Google Scholar]
- 27. Levy T, Fotopoulos G, Walker S, Rex S, Octave M, Paul V, Amrani M: Randomized controlled study investigating the effect of biatrial pacing in prevention of atrial fibrillation after coronary artery bypass grafting. Circulation 2000; 102: 1382–1387 [DOI] [PubMed] [Google Scholar]
- 28. Daoud EG, Dabir R, Archambeau M, Morady F, Strickberger SA: Randomized, double‐blind trial of simultaneous right and left atrial epicardial pacing for prevention of post‐open heart surgery atrial fibrillation. Circulation 2000; 102: 761–765 [DOI] [PubMed] [Google Scholar]
- 29. Blommaert D, Gonzalez M, Mucumbitsi J, Gurne O, Evrard P, Buche M, Louagie Y, Eucher P, Jamart J, Installe E, De Roy L: Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. J Am Coll Cardiol 2000; 35: 1411–1415 [DOI] [PubMed] [Google Scholar]
- 30. Daoud EG, Snow R, Hummel JD, Kalbfleisch SJ, Weiss R, Augostini R: Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: A meta‐analysis. J Cardiovasc Electrophysiol 2003; 14: 127–132 [DOI] [PubMed] [Google Scholar]
- 31. Archbold RA, Schilling RJ: Atrial pacing for the prevention of atrial fibrillation after coronary artery bypass graft surgery: A review of the literature. Heart 2004; 90: 129–133 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32. Debrunner M, Naegeli B, Genoni M, Turina M, Bertel O: Prevention of atrial fibrillation after cardiac valvular surgery by epicardial, biatrial synchronous pacing. Eur J Cardiothorac Surg 2004; 25: 16–20 [DOI] [PubMed] [Google Scholar]
- 33. Daubert JC, Mabo P: Atrial pacing for the prevention of postoperative atrial fibrillation: How and where to pace? J Am Coll Cardiol 2000; 35: 1423–1427 [DOI] [PubMed] [Google Scholar]
- 34. Fareh S, Villemaire C, Nattel S: Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia‐induced atrial electrical remodeling. Circulation 1998; 98: 2202–2209 [DOI] [PubMed] [Google Scholar]