A 68-year-old male patient presented to the cardiothoracic surgery (CT) surgery clinic for follow-up after recent hospital discharge. During the hospitalization, the patient was found to have non-ST-elevation myocardial infarction (NSTEMI). He underwent left-heart catheterization (LHC) and was found to have triple-vessel disease. No intervention was performed, and the patient was scheduled for elective coronary artery bypass graft surgery (CABG). During this visit, the patient wonders what his risk of developing atrial fibrillation (AF) after surgery are and if there are ways to minimize this risk because his uncle suffered from AF after open-heart surgery.
Which of the following is an option to reduce his risk of post-operative AF?
Show Answer
The correct answer is: C. Discuss the possibility of performing posterior left pericardiotomy during CABG
Posterior left pericardiotomy has been shown to be a promising strategy to reduce the risk of post-operative AF in retrospective studies. The recent PALACS trial1 was a single center randomized controlled prospective study comparing post-operative AF incidence in posterior left pericardiotomy versus no treatment (212 vs. 208) in patients without AF history undergoing elective coronary arteries, aortic valve, or ascending aorta open heart surgery. Posterior left pericardiotomy was associated with a large and significant reduction in the incidence of postoperative AF in patients (17% vs. 32%, p=0·0007) with no added risk or side-effects compared with no intervention. The evidence suggests that posterior left pericardiotomy should be considered during most cardiac surgery operations. A large pragmatic confirmatory multi-center trial is indicated to further characterize the potential clinical benefits of this intervention.
References
Gaudino M, Sanna T, Ballman KV, et al. Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial. Lancet 2021;398:2075-83.
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