Effectiveness of biatrial pacing in reducing early postoperative atrial fibrillation after the maze procedure

Interatrial conduction abnormalities have an important role in the initiation of recurrent atrial fibrillation (AF) after the maze procedure. Biatrial pacing or single atrial pacing alters the site and timing of atrial depolarization and may improve restoration of sinus rhythm after the maze procedure. To further evaluate whether biatrial pacing is superior to single atrial or no pacing, we performed a randomized prospective study on 240 patients with a full maze procedure to compare the effectiveness with different pacing approaches in the postoperative period. Between 2002 and 2010, 240 patients undergoing mitral +/- tricuspid valve surgery concomitant with the maze procedure were randomized into three equal groups: Group I using overdrive biatrial pacing, Group II utilizing single atrial pacing and Group III without pacing. The atria were paced continuously in Atrium paced, Atrium sensed, and pacemaker Inhibited in response to sensed beat (AAI) mode at a rate of 80 pulses per minute or 10 pulses above the underlying rate for 5 days. The endpoints were the onset of AF or discharge. The incidence of recurrent postoperative atrial fibrillation was significantly less in Group I with 9 of 80 patients (11%) incurring atrial fibrillation compared with 23 of 80 patients (28%) in Group II (P < 0.01) and 29 of 80 patients in Group III (P < 0.01). The length of hospital stay and the mean costs of hospital stay were significantly lower in the biatrial pacing group (P < 0.05). Biatrial overdrive pacing is well tolerated and more effective in preventing the early recurrence of atrial fibrillation after the maze procedure. The impacts of the long-term results with the maze procedure require further study.