Archbold R A, Schilling R J
Department of Cardiology, London Chest Hospital, London, UK.
Heart. 2004 Feb;90(2):129-33. doi: 10.1136/hrt.2003.015412.
Atrial fibrillation (AF) occurs in 20-40% of patients after coronary artery bypass graft surgery (CABG) and contributes to increased morbidity and expenditure after CABG. The limited efficacy of pharmacological treatment to prevent post-CABG AF has stimulated research into alternative prophylactic strategies for the arrhythmia. This article critically reviews the trial evidence in the literature regarding the efficacy of epicardial atrial pacing to prevent post-CABG AF. Thirteen randomised controlled trials of either right, left, or biatrial pacing to prevent post-CABG AF were identified. Overall, prophylactic biatrial epicardial pacing appears to be effective prophylaxis against post-CABG AF and to reduce postoperative hospital stay. The efficacy of single site right or left atrial pacing is less clear. Further data are required to determine both the efficacy of single site atrial pacing and the cost effectiveness of pacing strategies to prevent AF after CABG.
冠状动脉旁路移植术（CABG）后，20%-40%的患者会发生心房颤动（AF），这会导致CABG术后发病率增加和费用上升。药物治疗预防CABG术后AF的疗效有限，这促使人们对该心律失常的替代预防策略展开研究。本文批判性地回顾了文献中关于心外膜心房起搏预防CABG术后AF疗效的试验证据。共确定了13项关于右心房、左心房或双心房起搏预防CABG术后AF的随机对照试验。总体而言，预防性双心房心外膜起搏似乎是预防CABG术后AF的有效方法，并可缩短术后住院时间。单部位右心房或左心房起搏的疗效尚不清楚。需要更多数据来确定单部位心房起搏的疗效以及预防CABG术后AF的起搏策略的成本效益。
