Title: Meta-Analysis of Randomized Trials on the Efficacy of Posterior Pericardiotomy in Preventing Atrial Fibrillation After Coronary Artery Bypass Surgery
This meta-analysis study evaluated the efficacy of a posterior pericardiotomy in preventing AF and supraventricular arrhythmias after coronary artery bypass grafting (CABG).
The authors found 6 prospective, randomized studies reporting on postoperative AF in 763 patients after undergoing a CABG. The cumulative incidence of AF was 10.8% in the posterior pericardiotomy group and 28.1% in the control group. Supraventricular arrhythmias occurred in 13.8% of the patients in the posterior pericardiotomy group and 35.4% in the control group. Early pericardial effusions (6.9% vs 46.2%) and late pericardial effusions were significantly less frequent in the posterior pericardiotomy group. Pleural effusions (22.2% vs 17.1%) and pulmonary complications (3.6% vs 2.5%) were only slightly more frequent in the posterior pericardiotomy group.
Conclusion: A posterior pericardiotomy seems to reduce significantly the incidence of postoperativeAF and supraventricular arrhythmias after undergoing a CABG. The marked reduction in the postoperative pericardial effusions after a posterior pericardiotomy suggests that pericardial effusions may be a main trigger involved in the development of AF after cardiac surgery.
JCE nov 2009
