Randomized, Double-Blind Trial of Simultaneous Right and Left Atrial Epicardial Pacing for Prevention of Post–Open Heart Surgery Atrial Fibrillation

Abstract

Background —The purpose of this study was to assess simultaneous right and left atrial pacing as prophylaxis for postoperative atrial fibrillation. Methods and Results —In a double-blind, randomized fashion, 118 patients who underwent open heart surgery were assigned to right atrial pacing at 45 bpm (RA-AAI; n=39), right atrial triggered pacing at a rate of ≥85 bpm (RA-AAT; n=38), or simultaneous right and left atrial triggered pacing at a rate of ≥85 bpm (Bi-AAT; n=41). Holter monitoring was performed for 4.8±1.4 days after surgery to assess for episodes of atrial fibrillation lasting >5 minutes. The prevalence of postoperative atrial fibrillation was significantly less in the patients randomized to biatrial AAT pacing when compared with the other 2 pacing regimens ( P =0.02). An episode of atrial fibrillation occurred in 4 (10%) of 41 patients in the Bi-AAT group compared with 11 (28%) of 39 patients in the RA-AAI group ( P =0.03 versus Bi-AAT) and 12 (32%) of 38 patients in the RA-AAT group ( P =0.01 versus Bi-AAT). There was no difference in the occurrence of atrial fibrillation between the right atrial AAI and AAT groups ( P =0.8). There was no significant difference among the 3 groups with regard to the number of postoperative hospital days (7.3±4.2 days), morbidity (5.1%), or mortality rate (2.5%). Conclusions —Simultaneous right and left atrial triggered pacing is well tolerated and significantly reduces the prevalence of post–open heart surgery atrial fibrillation.