Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation

Purpose Post-operative atrial fibrillation (POAF) is a common complication after cardiac surgery and often leads to poorly tolerated fast ventricular rates. Negative dromotropic drugs are not always effective and may not be well tolerated in heart failure patients. Aim of this study is to verify if...

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Published in:Journal of interventional cardiac electrophysiology 2009, Vol.24 (1), p.37-45
Main Authors: Rossi, Pietro, Bianchi, Stefano, Barretta, Antonio, Della Scala, Alberto, Kornet, Lilian, De Paulis, Ruggero, Bellisario, Alessandro, D’Addio, Vittorio, Pavaci, Herribert, Miraldi, Fabio
Format: Article
Language:English
Subjects:
Adipose Tissue
Atrial Fibrillation - etiology
Atrial Fibrillation - prevention & control
Cardiac Pacing, Artificial - methods
Cardiac Surgical Procedures - adverse effects
Cardiology
Feasibility Studies
Female
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Pericardium
Treatment Outcome
Vagus Nerve
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Summary:Purpose Post-operative atrial fibrillation (POAF) is a common complication after cardiac surgery and often leads to poorly tolerated fast ventricular rates. Negative dromotropic drugs are not always effective and may not be well tolerated in heart failure patients. Aim of this study is to verify if high-frequency stimulation of the right inferior fat pad (RIFPS) allows an effective decrease in ventricular rate (VR) during POAF. Methods We enrolled 32 consecutive patients submitted to bypass; during surgery, a temporary heart wire was implanted in a site where RIFPS evoked a functional AV block. During POAF, RIFPS was delivered from the heart wire to decrease VR. Results Intra-operative RIFPS evoked complete AV block in 29 patients (91%). Fourteen patients (44%) developed POAF (mean VR 127 ± 12 bpm). In these patients, RIFPS achieved a 25% reduction of VR and complete AV block with 6.0 ± 1.9 and 7.5 ± 1.8 V (duration 0.2 ms, frequency 50 Hz), respectively. Conclusion Epicardial RIFPS represents an effective and feasible technique to decrease VR during POAF.
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-008-9286-2