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International Society For Minimally Invasive Cardiothoracic Surgery

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Is It Possible To Prevent New-onset Atrial Fibrillation After Coronary Surgery?
Amiran Revishvili, Vadim Popov, Egor Malyshenko, Maksim Anishchenko, Giorgiy Edzhibiya.
A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation.

BACKGROUND. New-onset postoperative atrial fibrillation (POAF) occurs in 30 to 40% of cases after coronary surgery and it has a big impact on mortality and morbidity. Efficacy of pharmacological prophylaxis is 10-15%, surgical prevention of atrial fibrillation is still controversial. METHODS. It is a single-center prospective randomized clinical trial (PULVAB) intended to compare prophylactic strategies of atrial fibrillation and evaluate the influence of radiofrequency pulmonary vein isolation (PVI) POAF after coronary artery bypass grafting surgery (CABG). Patients were allocated into 3 groups. 1st group is conventional CABG group, 2nd group is CABG with PVI and 3rd group is CABG with PVI and postoperative amiodarone administration. In pilot part of this study, we have enrolled 96 patients: 34, 29 and 33 patients in each group respectively. Baseline characteristics did not differ in both groups. Inclusion criteria are 2 or more coronary arteries to be bypassed and absence of AF history. Exclusion criteria are history of AF and severe comorbidities. Primary end-points were POAF and MACCE up to 1 year. Secondary end-points - cardiopulmonary bypass (CPB) time, cross-clamping time, ventilation time.RESULTS. MACCE were 0 in each group, the incidence of POAF in CABG-PVI-amiodarone group was significantly lower - 6,1% vs 32,4% in CABG group and 20,7% in CABG-PVI group. There was no significant difference in POAF between groups I and II (p = 0.298) and also between groups II and III (p=0.086). Statistically significant difference occurred between patients from groups I and III (p = 0.0065).
There were better results in CABG-PVI-amiodarone group in such secondary end-points: ICU-stay (p=0.0037) and ventilation time (p=0.004) comparing to CABG-PVI group. Bleeding, wound complications, perioperative myocardial infarction and stroke were also not noted. Sinus rhythm at discharge was recorded in 97.1% (group I); 96.7% (group II) and 97% (group III), respectively (p≥0.05). CONCLUSION. The combination of PVI and amiodarone administration reveals significant positive results in the prevention of new-onset POAF.


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