Does the Temporary Right Atrial Overdrive Pacing Enhance an Effect on Landiolol to Prevent Atrial Fibrillation after Off-pump Coronary Artery Bypass Grafting?

Abstract

Atrial fi brillation (AF) is one of the most frequent complications following cardiac surgery, with incidence ranging from 30% to 60%-. Postoperative AF is associated with complications including an increased risk of stroke and a need for additional treatment, as well as a prolonged intensive care unit or hospital stay and increased hospitalization costs. The incidence of postoperative AF in off-pump coronary artery bypass grafting (CABG) is similar to conventional CABG with cardiopulmonary bypass. β-blockers are widely used during the perioperative periods in cardiac surgery. The ACCF/AHA guidelines recommend that β-blockers should be administered for at least 24 hours before CABG in all patients without contraindications, should be reinstituted as soon as possible after CABG, and should be prescribed to all CABG patients at the time of hospital discharge. Landiolol hydrochloride (Onoact ® ; Ono Pharmaceutical Co., Osaka, Japan), is an ultrashort acting β-blocker, with a halflife of 4 minutes and a higher β-selectivity than any currently available β-blocker. Recently, some meta-analyses have shown that landiolol administration signifi cantly reduces the incidence of postoperative AF following cardiac surgery-. The effectiveness of landiolol was similar for both valvular surgery and CABG, even with off-pump CABG. High right atrial overdrive pacing for patients with paroxysmal AF reduces the recurrence of AF when compared with ventricular demand pacing in observational and controlled clinical trials . Several randomized controlled studies of either right, left, or biatrial pacing to prevent postoperative AF following CABG or valve surgery and to reduce the length of the hospital stay were performed-. Although the role of postoperative β-blockers in combination with atrial pacing has been pointed out as benefi cial, the effi cacy of this combination therapy is still a matter of debate. This Original Article