TY - JOUR
T1 - Mapping and ablation of autonomic ganglia in prevention of postoperative atrial fibrillation in coronary surgery
T2 - Maappafs atrial fibrillation randomized controlled pilot study
AU - Al-Atassi, Talal
AU - Toeg, Hadi
AU - Malas, Tarek
AU - Lam, Buu Khanh
N1 - Funding Information:
This study was funded by an unrestricted grant from the University of Ottawa Heart Institute. Equipment was provided in kind by Medtronic, Inc.
Publisher Copyright:
© 2014 Canadian Cardiovascular Society.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: Postoperative atrial fibrillation (POAF) remains common after coronary artery bypass grafting (CABG). Limited efforts to intervene on cardiac autonomic ganglionic plexi (AGP) during surgery show mixed results. In this pilot study, we evaluated the safety and feasibility of map-guided ablation of AGPs during isolated CABG in the prevention of POAF. Methods: In this pilot study, patients undergoing isolated CABG were randomized into an intervention group (mapping and ablation of AGP [AGP+] group), and a control group (no mapping and ablation [AGP-] group). Using high-frequency stimulation, active AGPs were identified and ablated intraoperatively using radiofrequency. Continuous rhythm monitoring, serum electrolytes, postoperative medications, and postoperative complications were recorded until discharge. Results: Randomization of 47 patients (24 AGP+ and 23 AGP-) resulted in similar baseline characteristics, past medical history, and preoperative medication use. The intervention added a median of 14 minutes to the operative time. The incidence of POAF, mean time inPOAF, and median length of stay in hospital were: AGP+ 21% vs AGP- 30%; AGP+ 298 minutes vs AGP- 514 minutes; AGP+ 5 days vs AGP- 6 days; respectively). Postoperative complications, medication use, and daily serum electrolyte profiles were similar in both groups. Conclusions: This pilot study demonstrated the safety and feasibility of mapping and ablation of AGP during CABG with minimal added operative time. Results further suggest a potentially clinically significant effect on POAF. A multicentre trial is warranted.
AB - Background: Postoperative atrial fibrillation (POAF) remains common after coronary artery bypass grafting (CABG). Limited efforts to intervene on cardiac autonomic ganglionic plexi (AGP) during surgery show mixed results. In this pilot study, we evaluated the safety and feasibility of map-guided ablation of AGPs during isolated CABG in the prevention of POAF. Methods: In this pilot study, patients undergoing isolated CABG were randomized into an intervention group (mapping and ablation of AGP [AGP+] group), and a control group (no mapping and ablation [AGP-] group). Using high-frequency stimulation, active AGPs were identified and ablated intraoperatively using radiofrequency. Continuous rhythm monitoring, serum electrolytes, postoperative medications, and postoperative complications were recorded until discharge. Results: Randomization of 47 patients (24 AGP+ and 23 AGP-) resulted in similar baseline characteristics, past medical history, and preoperative medication use. The intervention added a median of 14 minutes to the operative time. The incidence of POAF, mean time inPOAF, and median length of stay in hospital were: AGP+ 21% vs AGP- 30%; AGP+ 298 minutes vs AGP- 514 minutes; AGP+ 5 days vs AGP- 6 days; respectively). Postoperative complications, medication use, and daily serum electrolyte profiles were similar in both groups. Conclusions: This pilot study demonstrated the safety and feasibility of mapping and ablation of AGP during CABG with minimal added operative time. Results further suggest a potentially clinically significant effect on POAF. A multicentre trial is warranted.
UR - http://www.scopus.com/inward/record.url?scp=84907994048&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907994048&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2014.04.018
DO - 10.1016/j.cjca.2014.04.018
M3 - Article
C2 - 25262862
AN - SCOPUS:84907994048
SN - 0828-282X
VL - 30
SP - 1202
EP - 1207
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 10
ER -