Comparison Of The Prophylactic Strategies In New On-set Atrial Fibrillation In Cabg.
Vadim Popov, MD, PhD, Egor Malyshenko, MD, Maxim Anishchenko, MD, PhD, Natalia Popova, MD, Amiran Revishvili, MD, PhD.
A.V.Visnevsky National Research Center of Surgery, Moscow, Russian Federation.
BACKGROUND: The rate of new onset atrial fibrillation (AF) after coronary bypass surgery (CABG) is 20-35% and worsens both short- and long-term CABG outcomes. The aim of this study is to evaluate the results of prophylactic strategies in new onset atrial fibrillation after myocardial revascularization.METHODS: The prospective RCT «PROPHYLACTIC PULMONARY VEINS ABLATION» (PULVAB-NCT03857711) includes 175 patients. The inclusion criteria are the CAD without anamnesis of AF. The exclusion criteria are urgent surgery, concomitant valvular heart disease, decompensation of chronic diseases. Patients are randomized into 4 groups: I group - conventional CABG (n=45), II group - conventional CABG with administration of amiodarone (n=42), III group - concomitant CABG and PVI (n=45) , IV group - concomitant CABG and PVI with administration of amiodarone(n=42). Primary endpoints are incidence of POAF, sinus rhythm, freedom from MACCE. Secondary endpoints: operation time, cross-clamping time, CPB time. Bipolar PVI was performed without aortic cross-clamping using parallel CPB before CABG. The LAA occlusion aren’t performed. There are no differences in clinical and demographic parameters and comorbidities. RESULTS: There were no incidents of in-hospital mortality. PVI did not increase time of the stages of operation: the operation time (р=0,14), cross-clamping time (р=0,19) and CPB (р=0,08) were consistent. There were no wound complications or bleeding or perioperative MI or stroke reported. There were 18(40%) cases of POAF in I group POAF, 14(33,3%) cases in II group, 7(15,5%) cases in III group, 2(4,8%) cases in IV group, respectively. No significant difference was found when comparing the groups I and II (p=0,41), groups II and III (p=0,23), III и IV(p=0,18). Significantly lower rates of POAF relative to group I was observed in group III (p=0,025) and IV (p=0,003), that can be caused by high preventive efficiency of both stand-alone PVI and the combination of PVI with amiodarone. By the time of discharge sinus rhythm had 95,5%; 97,6%; 97,6% and 95,5% patients in groups I, II, III и IV, respectively (p=0,21). There was no long-term mortality in 12 months-follow up. Freedom from MACCE was 91,5%, 94,5%, 98% and 98% in four groups, respectively. Freedom from AF/AFL in 12 months was 81,5%, 84,5%, 92,8% and 98% in four groups, respectively.
CONCLUSIONS:Stand-alone bipolar PVI or in combination with amiodarone as a preventive approach significantly reduces incidence of new onset AF after CABG and don’t increase rates of short- and long-term complications.
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