Atrial Pacing May Decrease the Incidence of Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery
At the Montreal General Hospital in 1994, the incidence of atrial fibrillation (AF) following coronary
artery bypass graft (CABG) surgery was 30%. With the goal of reducing the incidence of this
complication, 20 patients (15 males and 5 females) undergoing CABG surgery were studied
prospectively for the occurrence of AF following a three-day "on demand" atrial pacing at 90 beats-
per-minute. The age range of the group was 39 to 79 years, with a mean age of 60 and a median age of
63. Two patients were categorized in NYHA class II, 13 in class III, and five in class IV. Of the latter
five, two patients received intravenous nitroglycerin preoperatively. ß-blockers were taken pre-
operatively by 13 patients, Ca2+ channel blockers by 12, and ACE inhibitors by two. Only one patient
had suffered a myocardial infarction within the last year. Preoperative ejection fractions ranged from
15 to 60% with a mean of 45%. In all cases, the CABG operation achieved complete revascularization
using left internal mammary artery (LIMA) grafts in addition to saphenous vein grafts. The average
number of bypasses performed was 3.15. Cardiac arrest was induced using intermittent cold blood
cardioplegia, and cardiopulmonary bypass time averaged 60 minutes. Aortic occlusion time averaged
36 minutes. Intraoperative inotrope use was infrequent, used intraoperatively with two cases requiring
neosynephrine, one case requiring levophed, and one case requiring dobutamine. Post-pacing cardiac
assessment revealed non-specific T wave abnormalities in five (25%) of patients, but no patient showed
any evidence of acute myocardial infarction. In no cases did any complications related to the atrial
pacing develop in the postoperative period. The results reveal that only two patients (15%) experienced
AF following, and one during, the three-day regimen of atrial pacing. Thus, this study provides
preliminary evidence of a decrease in the incidence of post-CABG AF using atrial pacing.
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