Biatrial pacing as a cost-effective strategy for prevention of atrial fibrillation after coronary artery bypass surgery

Atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) constitutes the most commonly sustained arrhythmia and results in prolonged hospitalization. The purpose of this study was to assess simultaneous right and left atrial pacing as prophylaxis for postoperative atrial fibrillation. One-hundred and twenty patients, without structural heart disease, who underwent CABG were classified into one of the following 3 groups: biatrial pacing (BAP), left atrial pacing (LAP), and no pacing (control). Atrial pacing was performed for 4 days. Post-CABG AF was significantly reduced in BAP group compared to single-site and control groups (BAP, 17.5%; LAP, 30%; control, 45%; P < 0.01). The mean length of hospital stay was significantly reduced in BAP group. Hospital charges were less in the BAP group compared to the other two groups. P-wave duration was significantly reduced by biatrial pacing and LAP compared to control group (before pacing, BAP: 69.2 ms; LAP: 73 ms, and after pacing, BAP: 58 ms; LAP: 64.2 ms respectively, P < 0.01). However, only those patients who remained in sinus rhythm had a significant reduction in mean P-wave duration after pacing therapy. Simultaneous right and left atrial pacing is well tolerated and is more effective in preventing post-CABG AF than single-site pacing and results in a shortened hospital stay. Identifying patients at risk for developing postoperative AF and using this prophylactic method may be the optimal cost-effective strategy.