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J Thorac Cardiovasc Surg 2011;142:989-994
© 2011 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Continuous biatrial pacing to prevent early recurrence of atrial fibrillation after the Maze procedure

^a Scripps Memorial Hospital, La Jolla, Calif
^b Shanxi Cardiovascular Hospital, Taiyuan, China

Read at the 91st Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pennsylvania, May 7–11, 2011.

Received for publication April 23, 2011; revisions received June 17, 2011; accepted for publication July 11, 2011.

^_* Address for reprints: William Wang, MD, 9850 Genesee Ave, Suite 560, La Jolla, CA 92037. (Email: wangmd100{at}gmail.com).

Objective: It has been suggested that overdrive biatrial pacing may prevent the recurrence of atrial fibrillation after the Maze procedure. To further evaluate this hypothesis, we performed a randomized prospective study in 100 patients undergoing valve surgery concomitant with a full Maze procedure to determine the effectiveness of biatrial pacing in the postoperative period to reduce early recurrence of atrial fibrillation.

Method: Between January 2002 and December 2008, 100 patients undergoing mitral valve ± tricuspid valve surgery concomitant with the Maze procedure were randomized into 2 equal groups: the study group using overdrive biatrial pacing and a control group without pacing. One pacing wire was attached to the crista terminalis area of the right atrium, and the other pacing wire was attached to the Bachmann’s bundle area located in the roof of the left atrium. The atria were paced continuously in AAI mode at a rate of 80 pulses per minute or 10 pulses above the underlying rate for 5 days. The end points were the onset of recurrent atrial fibrillation or discharge.

Results: The incidence of recurrent postoperative atrial fibrillation was significantly less in the study group, with 6 of 50 patients (12%) incurring atrial fibrillation compared with 18 of 50 patients (36%) in the control group (P < .01). The length of hospital stay was significantly reduced in the study group (P < .01), and the mean costs of hospital stay were significantly lower in the control group (P < .05).

Conclusions: Biatrial overdrive pacing is well tolerated and more effective in preventing the early recurrence of atrial fibrillation after the Maze procedure. This therapy also results in shortened hospital stays and decreased hospital costs. However, the impacts of the long-term results in the Maze procedure require further study.

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