Atrial pacing for the prevention of atrial fibrillation after coronary artery bypass graft surgery: a review of the literature

Atrial fibrillation (AF) occurs in 20 - 40% of patients after coronary artery bypass graft surgery (CABG) and contributes to increased morbidity and expenditure after CABG. The limited efficacy of pharmacological treatment to prevent post-CABG AF has stimulated research into alternative prophylactic strategies for the arrhythmia. This article critically reviews the trial evidence in the literature regarding the efficacy of epicardial atrial pacing to prevent post-CABG AF. Thirteen randomised controlled trials of either right, left, or biatrial pacing to prevent post-CABG AF were identified. Overall, prophylactic biatrial epicardial pacing appears to be effective prophylaxis against post-CABG AF and to reduce postoperative hospital stay. The efficacy of single site right or left atrial pacing is less clear. Further data are required to determine both the efficacy of single site atrial pacing and the cost effectiveness of pacing strategies to prevent AF after CABG.