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Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation

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Abstract

Purpose

Post-operative atrial fibrillation (POAF) is a common complication after cardiac surgery and often leads to poorly tolerated fast ventricular rates. Negative dromotropic drugs are not always effective and may not be well tolerated in heart failure patients. Aim of this study is to verify if high-frequency stimulation of the right inferior fat pad (RIFPS) allows an effective decrease in ventricular rate (VR) during POAF.

Methods

We enrolled 32 consecutive patients submitted to bypass; during surgery, a temporary heart wire was implanted in a site where RIFPS evoked a functional AV block. During POAF, RIFPS was delivered from the heart wire to decrease VR.

Results

Intra-operative RIFPS evoked complete AV block in 29 patients (91%). Fourteen patients (44%) developed POAF (mean VR 127 ± 12 bpm). In these patients, RIFPS achieved a 25% reduction of VR and complete AV block with 6.0 ± 1.9 and 7.5 ± 1.8 V (duration 0.2 ms, frequency 50 Hz), respectively.

Conclusion

Epicardial RIFPS represents an effective and feasible technique to decrease VR during POAF.

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Abbreviations

AF:

atrial fibrillation

AT:

atrial tachycardia

LVEF:

left ventricular ejection fraction

POAF:

post-operative atrial fibrillation

VR:

ventricular rate

HF:

heart failure

AV:

atrio-ventricular

RIFP:

right inferior vagal fat pad

RIFPS:

right inferior vagal fat pad stimulation

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Acknowledgments

The authors thank Giancarlo Monari for his technical support and Tiziana De Santo (Medtronic Italy) for her assistance in statistical analysis.

Author information

Authors and Affiliations

  1. Department of Medicine, Unit of Electrophysiology, Belcolle Hospital, Viterbo, Italy

    Pietro Rossi

  2. Division of Cardiology, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy

    Stefano Bianchi

  3. Division of Cardiac Surgery, University “La Sapienza”, Rome, Italy

    Antonio Barretta, Vittorio D’Addio, Herribert Pavaci & Fabio Miraldi

  4. Medtronic Italy, Sesto S. Giovanni, Milan, Italy

    Alberto Della Scala

  5. Medtronic BRC, Maastricht, The Netherlands

    Lilian Kornet

  6. Division of Cardiac Surgery, European Hospital, Rome, Italy

    Ruggero De Paulis & Alessandro Bellisario

  7. Via Nerva 4, 00012 Guidonia-Montecelio, Rome, Italy

    Pietro Rossi

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  1. Pietro Rossi
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  2. Stefano Bianchi
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Correspondence to Pietro Rossi.

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A. Della Scala and L. Kornet are employees of Medtronic. No other conflicts of interest exist.

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Rossi, P., Bianchi, S., Barretta, A. et al. Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation. J Interv Card Electrophysiol 24, 37–45 (2009). https://doi.org/10.1007/s10840-008-9286-2

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  • DOI: https://doi.org/10.1007/s10840-008-9286-2

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