Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery

Blommaert, Dominique; González, M.; Mucumbitsi, Joseph; Gurné, Olivier; Evrard, Patrick; Buche, Michel; Louagie, Yves; Eucher, Philippe; Jamart, Jacques; Installé, Etienne; Roy, Luc De

doi:10.1016/s0735-1097(00)00608-2

Cited by 118 publications

(58 citation statements)

References 20 publications

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“…Atrial pacing, on the other hand, was a predictor of freedom from developing AF, which is in accordance with previous observations. 14,15 The incidence of postoperative AF was higher with the use of dopamine and dobutamine, both of which are predominantly ␤ 1 -adrenergic receptor agonists, compared with phenylepherine, which in therapeutic doses is predominantly an agonist of ␣-adrenergic receptors and lacks direct stimulatory effects on atrial myocardium. In fact, the prevalence of AF in patients in whom phenylepherine was used was similar to those in whom no adrenergic drug was used.…”

Section: Discussionmentioning

confidence: 99%

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery

et al. 2005

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SummaryBackground: Use of adrenergic (inotropic and vasopressor) drugs is common after cardiac surgery.Hypothesis: The study was undertaken to evaluate the role of postoperative adrenergic drug use as a predictor of postoperative atrial fibrillation (AF) after cardiac surgery.Methods: The study population consisted of 199 patients post cardiac surgery. Postoperative adrenergic drug use and the baseline and clinical variables were analyzed as possible predictors of postoperative AF.Results: Of 199 patients, postoperative AF occurred in 59 patients (incidence 30%). The adrenergic drugs were used in 127 (64%) patients. Postoperative AF occurred in 49 of the 127 patients (39%) with and in 10 of the 72 patients (14%) without adrenergic drug use (p < 0.01). By univariate analyses, postoperative adrenergic drug use, age, left ventricular hypertrophy, left atrial size, valve surgery, aortic valve replacement, cross clamp time, bypass time, postoperative ventricular pacing, and hours in intensive care unit were predictors of development of postoperative AF. Atrial pacing was a predictor of freedom from developing AF. By multivariate logistic regression analysis, adrenergic drug use was an independent predictor of postoperative AF (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.38-8.12, p = 0.016). Two other independent predictors were valve surgery (OR 2.88, 95% CI 1.31-6.35, p = 0.002) and age (OR 10.73, p =

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Section: Discussionmentioning

confidence: 99%

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery

et al. 2005

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“…[51][52][53][54][55][56][57][58][59][60][61] These trials were small, varying in size of treatment groups from 9 to 100 patients. Treatment protocols used different locations of pacing electrodes (right atrial, 51-57 left atrial, 54,57 and biatrial pacing.…”

Section: Pacingmentioning

confidence: 99%

“…Trials also differed in pacing algorithms; some used simple overdrive at a fixed heart rate, 53,55,59 and others used more complex overdrive algorithms. 51 …”

Section: Pacingmentioning

confidence: 99%

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

et al. 2002

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Background-Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. Methods and Results-Fifty-two randomized trials (controlled by placebo or routine treatment) of ␤-blockers, sotalol, amiodarone, or pacing were identified by systematic literature search.

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“…[20][21][22][23] Recently, several reports have shown that multisite temporary atrial pacing via epicardial electrodes placed during surgery might be effective in preventing postoperative AF. [24][25][26][27][28][29][30][31][32] In a double-blind, randomized study, Daoud et al evaluated the effects of different pacing modes in 118 patients who had undergone open heart surgery. 28 In this study, patients were randomized to one of the following three groups: right atrial pacing with an inhibited mode at a rate of 45 beats/min; right atrial overdrive pacing with a triggered mode ≥ 10 beats greater than the patient's intrinsic (but not < 85 beats/min) rate; and biatrial overdrive pacing with a triggered mode ≥ 10 beats greater than the patient's intrinsic (but not < 85 beats/min) rate.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of triple-site triggered atrial pacing for prevention of atrial fibrillation after coronary artery bypass graft surgery

et al. 2005

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SummaryBackground: 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 triplesite 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.

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Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery

Abstract: We conclude that continuous atrial pacing with an algorithm for dynamic overdrive reduces significantly incidence of AF the second day after CABG surgery, particularly in patients with preserved left ventricular function.

Cited by 118 publications

References 20 publications

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

Effectiveness of triple-site triggered atrial pacing for prevention of atrial fibrillation after coronary artery bypass graft surgery

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