Chavan Chandrakant, Karmalkar Mukund, Badani Rajesh, Sharada K, Rani Usha, Rao Prasad, Subramanyam Ram, Narasimhan C
CARE Hospitals, The Institute of Medical Sciences, Hyderabad.
Indian Pacing Electrophysiol J. 2011 Feb 7;10(12):529-35.
In patients undergoing coronary artery bypass surgery (CABGS), occurrence of atrial fibrillation (AF) is common in the postoperative period and is associated with increased morbidity with longer intensive unit care (ICU) and hospital stay. Prevention with antiarrhythmic drugs is of limited success and associated with significant side effects. Therefore alternative approaches, such as Bachmann Bundle pacing, are required.
154 consecutive patients, mean age 58±8.8 years, including 134 males and 20 females, were randomized to three groups; Group I : No pacing n= 54, Group II : RA pacing n= 52, Group III : Bachmann Bundle pacing n= 48. All the groups were well matched with regard to age, left atrial size, ejection fraction and use of beta blockers. Patients in Groups II and III were continually paced at a rate of 100 beats per minute (bpm) or at 10 bpm more than patients' intrinsic heart rate. All the patients were monitored for 72 hours by telemetry and occurrence of AF was noted. Incidence of AF was 0% (none of 48 patients) in Group III as compared to 16.6% in Group I (9 of 54 patients) (p 0.003) and 12.5% in Group II (5 of 52 patients) (p 0.03). There was a trend towards shorter ICU stay in Group III (3.9 days) as compared to Group II (4.5 days) and Group I (4.1 days). Among the three groups, the reduction in mean P wave duration also was greater in Bachmann bundle paced group.
In patients undergoing CABGS, Bachmann bundle pacing is superior to right atrial / no pacing in the post operative period for preventing occurrence of AF and reducing ICU stay, commensurate with a reduction in mean P wave duration on surface ECG.
在接受冠状动脉搭桥手术（CABGS）的患者中，术后心房颤动（AF）的发生很常见，并且与重症监护病房（ICU）和住院时间延长导致的发病率增加相关。使用抗心律失常药物进行预防的效果有限且伴有明显副作用。因此，需要诸如巴赫曼束起搏等替代方法。
154例连续患者，平均年龄58±8.8岁，包括134例男性和20例女性，被随机分为三组；第一组：无起搏，n = 54；第二组：右心房起搏，n = 52；第三组：巴赫曼束起搏，n = 48。所有组在年龄、左心房大小、射血分数和β受体阻滞剂的使用方面匹配良好。第二组和第三组的患者以每分钟100次心跳（bpm）或比患者自身心率快10 bpm的速率持续起搏。所有患者通过遥测监测72小时，并记录AF的发生情况。第三组AF的发生率为0%（48例患者中无1例），而第一组为16.6%（54例患者中有9例）（p < 0.003），第二组为12.5%（52例患者中有5例）（p < 0.03）。与第二组（4.5天）和第一组（4.1天）相比，第三组的ICU住院时间有缩短的趋势（3.9天）。在三组中，巴赫曼束起搏组平均P波持续时间的缩短也更大。
在接受CABGS的患者中，在术后预防AF发生和缩短ICU住院时间方面，巴赫曼束起搏优于右心房起搏/无起搏，这与体表心电图上平均P波持续时间的缩短相一致。
