Effect of atrial pacing on post-operative atrial fibrillation following coronary artery bypass grafting: Pairwise and network meta-analyses

Background: To determine the effect of atrial pacing on the rate of post-operative atrial fibrillation (POAF) following coronary artery bypass grafting.

Methods: After a systematic literature search, randomized clinical trials (RCTs) comparing any combination of no pacing (NP), bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA) pacing were included. Pairwise and network meta-analyses were performed using the generic inverse variance method. The primary outcome was POAF incidence. Secondary outcomes were postoperative bleeding, infection, and operative mortality. Leave-one-out and meta-regression were done.

Results: Fourteen RCTs were included with a total of 1727 patients. Compared with NP, any form of atrial pacing was significantly associated with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.35-0.69). BiA pacing was associated with the larger risk reduction (OR: 0.36; 95% CI: 0.20-0.64 vs. 0.59; 95% CI: 0.34-1.02 for LA and 0.64; 95% CI: 0.38-1.07 for RA). Secondary outcomes were similar between the no pacing and pacing groups. On meta-regression, age and the use of continuous monitoring were associated with lower reduction of the incidence of POAF. In the network meta-analysis, BiA pacing ranked the best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21-0.55).

Conclusions: Compared to other pacing modalities, BiA pacing is associated with lower rates of POAF following CABG.