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(Chest. 2005;128:36S-38S.)
© 2005 American College of Chest Physicians

The Role of Cardiac Pacing*

American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery

William H. Maisel, MD, MPH and Andrew E. Epstein, MD

* From the Brigham and Women’s Hospital (Dr. Maisel), Boston, MA; and the University of Alabama at Birmingham (Dr. Epstein), Birmingham, AL.

Correspondence to: William H. Maisel, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: wmaisel{at}partners.org

New-onset atrial fibrillation (AF) occurs frequently after cardiac surgery. The utility of prophylactic atrial pacing to prevent AF following cardiac surgery has been investigated in a number of trials, but clinical guidelines for its use are lacking. Trials of prophylactic atrial pacing to prevent AF following cardiac surgery were identified by searching PubMed, the Cochrane database, selected medical journals, and references in selected articles. Nine randomized controlled trials were identified that addressed prophylactic atrial pacing after cardiac surgery to prevent AF. Prophylactic right atrial pacing and prophylactic left atrial pacing have yielded inconclusive results. Prophylactic biatrial pacing (BAP) reduced the incidence of AF significantly in four studies, reduced it nonsignificantly in one study, and had no effect in one study. On the basis of the literature that was reviewed and graded for quality, it was concluded that prophylactic atrial pacing to prevent AF after cardiac surgery is safe. We recommend that BAP be considered, particularly in patients who are at high risk for the development of postoperative AF.

Key Words: atrial fibrillation • atrial pacing • atrial premature beats • coronary artery bypass graft






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