Nonpharmacologic Treatment of Postoperative Atrial Fibrillation

  • Richard J. Lewis
  • Jonathan S. Steinberg
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 222)


Atrial fibrillation (AF) remains one of the more serious and common postoperative complications in patients undergoing coronary artery bypass graft (CABG) surgery. An incidence of 10-50% has been reported in numerous studies over the last two decades [1-8, see also chapter 3]. Efforts to prevent postoperative AF have included refinements in intraoperative surgical technique, use of pre-, infra- and postoperative beta-blockers, prophylactic antiarrhythmic drugs, and multiple temporary cardiac pacing strategies.


Atrial Fibrillation Coronary Artery Bypass Graft Atrial Pace Sick Sinus Syndrome Postoperative Atrial Fibrillation 
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  1. 1.
    Langan MS and Horowitz LN. Cardiac surgery and cardiac trauma in current management of arrhythmia. 1991 Ed. Horowitz Decker, Inc. p 273.Google Scholar
  2. 2.
    IMichelson EL, Morganroth J, MacVaugh H III. Postoperative arrhythmias after coronary artery and cardiac valvular surgery detected by long-term electrocardiographic monitoring. Am Heart J 1979;97:442–8.CrossRefGoogle Scholar
  3. 3.
    Rubin DA, Nieminski KE, Reed GE, Herman MV. Predictors, prevention and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations. J. Thoracic Cardiovasc Surg 1987;94:331–5.Google Scholar
  4. 4.
    Laver MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis 1989;31:367–78.CrossRefGoogle Scholar
  5. 5.
    Crosby LJ, Pifalo WB, Woll KR, Burkholder JA. Risk factors for atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 1990;66:1520–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Leitch JW, Thompson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990;100:338–42.PubMedGoogle Scholar
  7. 7.
    Creswell LL, Shuessler RB, Rosenblum M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56:539–49.CrossRefPubMedGoogle Scholar
  8. 8.
    Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS. Atrial fibrillation following coronary artery bypass graft surgery. JAMA 1996;276:300–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Pauli DL, Tidwell SL, Guyton SW, Harvey E, Woolf RA, Holmes JR, Anderson RP. Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery. Am J Surg 1997;173:419–21.CrossRefGoogle Scholar
  10. 10.
    Fontan F, Madonna F, Naftel DC, Kirklin JW, Blackstone EH, Digerness S. Modifying myocardial management in cardiac surgery: a randomized trial. Eur J Cardiothorac Surg 1992;6:127–36.CrossRefPubMedGoogle Scholar
  11. 11.
    Butler J, Chong JL, Rocker GM, Pillai R, Westaby S. Atrial fibrillation after coronary artery bypass grafting: a comparison of cardioplegia versus intermittent aortic cross-clamping. Eur J Cardiothorac Surg 1993;7:23–25.CrossRefPubMedGoogle Scholar
  12. 12.
    The warm heart investigators. Randomized trial of hormothermic versus hypothermic coronary bypass surgery. Lancet 1994;343:559–63.CrossRefGoogle Scholar
  13. 13.
    Daoud EG, Strickberger SA, Man KC, et al. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 1997;337:1785–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Olshansky B. Post CABG IV amiodarone decreases incidence of atrial fibrillation — Results from ARCH. Am J Cardiol 1996;78:27–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Moss AJ, Rivers RJ, Cooper M. Long-term pervenous atrial pacing from the proximal portion of the coronary vein. JAMA 1969;209:543.CrossRefPubMedGoogle Scholar
  16. 16.
    Davies JG, Sowton GE. Electrical threshold of the human heart. Br Heart J 1996;28:231CrossRefGoogle Scholar
  17. 17.
    Sutton R. Sinus node disease in clinical cardiac pacing [Ed Ellenbogen KA, Kay GN, Wilkoff BL] Saunders 1995; pp 284–303.Google Scholar
  18. 18.
    Sutton R, Kenny RA. The natural history of sick sinus syndrome. PACE 1986;9:1110–1114.PubMedGoogle Scholar
  19. 19.
    Rosenquist M, Brandt J, Schüler H. Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 1988;117:16–22.CrossRefGoogle Scholar
  20. 20.
    Lamas GA, Estes NM III, Schneller S et al. Does dual-chamber or atrial pacing prevent atrial fibrillation? The need for a randomized controlled trial. PACE 1992;15:1109–1113.PubMedGoogle Scholar
  21. 21.
    Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol 1992;19:1542–1549.CrossRefPubMedGoogle Scholar
  22. 22.
    Santini M, Alexidou G, Ansalone G, et al. Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 1990;65:729CrossRefPubMedGoogle Scholar
  23. 23.
    Anderson HR, Thuesen L, Bagger JP, Vesterlund T, Block Thomsen PE. Prospective randomized trial of atrial versus ventricular pacing in sick sinus syndrome. Lancet 1994;344:1523–1528.CrossRefGoogle Scholar
  24. 24.
    Neilsen JC, Pedersen AK, Mortensen PT, Thuesen L, Vesterlund T, Block Thomsen PE et al. Atrial versus ventricular pacing in sick sinus syndrome. Long term follow-up in a prospective randomized trial of 225 consecutive patients [abstract] PACE 1997;20(part II):1458.Google Scholar
  25. 25.
    Feuer JM, Shandling AH, Messenger JC, Castellanet CD, Thomas LA. Influence of cardiac pacing mode on long-term development of atrial fibrillation. Am J. Cardiol 1989;64:1376–1379.CrossRefPubMedGoogle Scholar
  26. 26.
    Lamas GA. Pacemaker mode selection and survival: a plea to apply the principles of evidenced-based medicine to cardiac pacing practice. Heart 1997;78:218–20.PubMedGoogle Scholar
  27. 27.
    Charles RG, Mc Comb JM. Systematic trial of pacing to prevent atrial fibrillation (STOP-AF), Heart 1997;78: 224–225.PubMedGoogle Scholar
  28. 28.
    Zoll PM. Resuscitation of the heart in ventricular standstill by external electric stimulation. N Engl J Med 1952;247:768–71.CrossRefPubMedGoogle Scholar
  29. 29.
    Shafiroff BGP, Under J. Effects of external electrical pacemaker stimuli on the human heart. J Thorac Surg 1957;33:544–50.PubMedGoogle Scholar
  30. 30.
    Benson DW Jr, Dunnigan A, Benditt DG, Schneider SP. Transesophageal cardiac pacing: History, application, technique. Clin Prog Pacing Electrophysiol 1984;2:360–72.Google Scholar
  31. 31.
    Waldo AL, MacLean WAH, Cooper TB et al. Use of temporarily placed epicardial atrial wire electrodes for the diagnosis and treatment of cardiac arrhythmias following open heart surgery. J Thorac Cardiovasc Surg 1978;76:500–505.PubMedGoogle Scholar
  32. 32.
    Takeda M, Furuse A, Kotsuka Y. Use of temporary atrial pacing in management of patients after cardiac surgery. Cardiovasc Surg 1996;4:623–27.CrossRefPubMedGoogle Scholar
  33. 33.
    Waldo AL, MacLean WA, Karp RB, Kouchoukos NT, James TN. Continuous rapid atrial pacing to control recurrent or sustained supraventricular tachycardias following open heart surgery. Circulation 1976;54:245–50.PubMedGoogle Scholar
  34. 34.
    Chung MK, Augostini RS, Asher CR et al. A randomized, controlled study of atrial overdrive pacing for the prevention of atrial fibrillation after coronary artery bypass surgery [abstract]. Circulation 1996;94(Suppl I):I–190.Google Scholar
  35. 35.
    Schweikert RA, Grady TA, Gupta N, Augostini RS et al. Atrial pacing in the prevention of atrial fibrillation after cardiac surgery: Results of the second postoperative pacing study (POPS-2). [abstract] J Am Coll Cardiol. 1998;31(SuppA):117A.CrossRefGoogle Scholar
  36. 36.
    Allessie MA, Lammers WJEP, Bonke FM et al. Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation. In ipes PP, Jalife J (ed): Cardiac elcctrophysiology and arrhythmias. Orlando FL, Grune & Stratton 1985, p 275.Google Scholar
  37. 37.
    Yu W, Chen S, Tai C, Feng A, Chang M. Effects of different atrial pacing modes on atrial electrophysiology: implicating the mechanisms of biatriat pacing in prevention of atrial fibrillation. Circulation. 1997; 96:2992–2996.PubMedGoogle Scholar
  38. 38.
    Daubert C, Mabo P, Bender V. Arrhythmia prevention by permanent atrial resynchronization in advanced interatrial block. Eur Heart J 1990; 11:237–42.Google Scholar
  39. 39.
    Saksena S, Prakash A, Hill M, Krol RB et al. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996;28:687–94.CrossRefPubMedGoogle Scholar
  40. 40.
    Prakash A, Saksena S, Hill M, Georgberidze I et al. Long-term results with dual and single atrial pacing for prevention of refractory atrial fibrillation [abstract]. Circulation 1996;94Suppl I: 1–68.Google Scholar
  41. 41.
    Prakash A, Saksena S, Kavshik R, Krol RB et al. Right and left atrial activation patterns during dual site right atrial pacing [abstract] PACE 1996;19:697.Google Scholar
  42. 42.
    Mittleman RS, Hill MRS, Mehra R, French SN et al. Evaluation of the effectiveness of righ atrial and biatrial pacing for the prevention of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) [abstract]. Circulation 1996;94Suppl I:I–68.Google Scholar
  43. 43.
    Orr WP, Tsui S, Stafford PJ, Pillai R, Bashir Y. Feasibility of synchronized bi-atrial pacing for preventing of atrial fibrillation after coronary artery bypass surgery — a pilot study [abstract]. J Am Coll Cardiol 1998;31:Suppl A 117A.CrossRefGoogle Scholar
  44. 44.
    Greenberg MD, Katz NM, Tempesta BJ, et al.. Atrial pacing following cardiovascular surgery reduces the incidence of postoperative atrial fibrillation [abstract]. Circulation 1998;98:I: I–509.Google Scholar
  45. 45.
    Goette A, Mittag J, Friedl A, Busk H et al. Continuous pacing Bachmann’s bundle after coronary artery bypass surgery [abstract] PACE 1998; Vol 21:April Part II p. 892.Google Scholar
  46. 46.
    Schneider MAE, Zrenner B, Karch MR, et al. Internal cardioversion of postoperatively occurring atrial fibrillation in patients undergoing cardiac surgery — first experiences using a new single lead catheter [abstract] PACE 1998; 21, Part II: 854.Google Scholar
  47. 47.
    Ortiz J, Sokolowski MC, Ayers GM, et al. Atrial defibrillation using temporary epicardial defibrillation stainless steel electrodes: studies in the canine sterile pericarditis model. J Am Coll Cardiol 1995; 26: 1356–1364.CrossRefPubMedGoogle Scholar
  48. 48.
    Smolick BL, Ortiz J, Ayers GM, et al. Successful atrial defibrillation with very-low-energy shocks by means of temporary epicardial wire electrodes. J Thorac Cardiovasc Surg 1996; 111: 392–398.CrossRefGoogle Scholar
  49. 49.
    Liebold A, Wahba A, Birnbaum DE. Low energy cardioversion with epicardial wire electrodes: new treatment of atrial fibrillation after open heart surgery. Circulation 1998; 98: 883–886.PubMedGoogle Scholar
  50. 50.
    Kleine P, Machner M, Nolte Th, Schäfer P, Laas J. Early versus late termination of atrial fibrillation following coronary artery bypass grafting using TADpole heart wires for internal defibrillation [abstract] PACE 1998; Vol 21:April, Part II p 952.Google Scholar
  51. 51.
    Kleine P, Blommaert D, van Nooten G, et al. Multicenter results of the Tadpole heartwire system used to treat postoperative atrial fibrillation [abstract]Google Scholar
  52. 52.
    Williams JM, Ungerleider GK, Lofland GK, Cox JL. Left atrial isolation. New Technique for the treatment of supraventricular arrhythmias. J Thorac Cardiovasc Surg 1980; 80:373.PubMedGoogle Scholar
  53. 53.
    Graffigna A, Pagani F, Minzinoni G, et al. Left atrial isolation associated with mitral valve operations. Ann Thorac Surg 1992; 54:1093–1098.CrossRefPubMedGoogle Scholar
  54. 54.
    Cox JL. The surgical management of cardiac arrhythmias. In Sabaston DC, Jr., Spencer FC (eds.): Gibbon’s Surgery of the Chest 4th ed. Philadelphia, WB Saunders, 1983 p 1566.Google Scholar
  55. 55.
    Ferguson TB, Jr. and Cox JL. Surgical treatment of cardiac arrhythmias. In Chatterjee K, Cheitlin MD, Karliner J, et al. (eds.): Cardiology an illustrated text/reference. Philadelphia, Lippincott/Gower, 1991 pp 6185–6214.Google Scholar
  56. 56.
    Cox JL, Boineau JP, Schuessler RB, et al. A review of surgery for atrial fibrillation. J Cardiac Electrophysiol 1991; 2: 541–561.CrossRefGoogle Scholar
  57. 57.
    Cox JI, Schuessler RB, D’Agostino HJ, et al. The surgical treatment of atrial fibrillation III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991; 101: 569–583.PubMedGoogle Scholar
  58. 58.
    Cox JL. The surgical treatment of atrial fibrillation: IV surgical technique. J Thorac Cardiovasc Surg 1991; 101:584–592.PubMedGoogle Scholar
  59. 59.
    Cox JL, Boineau JP, Schuessler RB et al. Five year experience with the MAZE procedure for atrial fibrillation. Ann Thorac Surg 1993;56:814–24.CrossRefPubMedGoogle Scholar
  60. 60.
    Hand DE, Lappas, Hogue CW, Cox JL. Perioperative transesophageal doppler echocardiographic verification of atrial transport function following the Maze procedure for atrial fibrillation. Surg Forum 1992; XLIII: 267–269.Google Scholar
  61. 61.
    McCarthy PM, Cosgrove DM, Castle LW, et al. Combined treatment of mitral regurgitation and atrial fibrillation with valvuloplasty and maze procedure. Am J Cardiol 1992; 72: 483–486.Google Scholar
  62. 62.
    Cox JL. Evolving applications of the Maze procedure for atrial fibrillation. Ann Thorac Surg 1993; 55: 578–580.CrossRefPubMedGoogle Scholar
  63. 63.
    Tamis JE, Vloka ME, Malhotra S, Mindich BP and Steinberg JS. Atrial fibrillation is common after minimally invasive direct coronary artery bypass surgery. [absract] J AM Coll Cardiol 1998;31:118.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Richard J. Lewis
    • 1
  • Jonathan S. Steinberg
    • 1
  1. 1.St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and SurgeonsNew York

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