Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation

Objective: Postoperative atrial fibrillation (POAF) is one of the most frequent complications encountered after heart surgery, and significantly increases complications and mortality. An obstructed chest tube, leaving unevacuated blood around the heart and lungs, can lead to atrial inflammation, which can trigger POAF. The aim of this study was to assess the effectiveness of chest drainage incorporating an active tube clearance (ATC) system in reducing the rate of POAF. Methods: This retrospective analysis based on 300 consecutive patients undergoing heart surgery compared 142 patients allocated to an ATC drainage protocol with 158 controls managed with standard chest drainage. Using a 1: 1 propensity score match, 214 patients were included in paired analysis (107 in each group). The primary endpoint was POAF. Results: Unmatched patients managed with ATC chest drainage protocol had a reduction of 34% in their POAF rate compared with those managed with standard drains (23% vs 35%, P = .01). In the matched cohort, ATC was associated with a reduction of 31% in the rate of POAF (24% vs 35%, P = .09) and a trend toward shorter postoperative length of stay (5.0 [4.0; 7.0] vs 6.0 [5.0; 8.0], P = .08). In multivariable analysis, chest drainage with ATC showed a protective effect on POAF with odds ratio of 0.5 (95% confidence interval, 0.1-0.9; P = .02). Conclusions: The use of an ATC chest drainage protocol may be associated with reduced POAF. Our results suggest that efforts to maintain chest tube patency could be useful to reduce the incidence of POAF.