Comparison Of Prophylactic Strategies of New-Onset Atrial Fibrillation In CABG

Amiran Sh Revishvili, Vadim A. Popov, Maksim M. Anishchenko, Egor S. Malyshenko, Natalia V. Popova, Kirill A. Kozyrin

 

A.V. Vishnevsky National Research Center of Surgery, Moscow, Russian Federation.

Background: New-onset AF occurs in 25-40% of patients after CABG, worsening outcomes . This study evaluated prophylactic strategies to prevent postoperative AF (POAF).

Methods: AF prevention strategies were studied in the prospective, single-center, randomized clinical trial - PULVAB (NCT03857711).  174 patients after CABG and without a history of atrial fibrillation were randomized into 4 groups: 1^st  - only conventional CABG (n=45), 2^nd - CABG + amiodarone (n=42), 3^rd - CABG + RF pulmonary vein isolation (PVI) (n=45), 4^th -  CABG + PVI + amiodarone (n=42). Primary endpoints were included freedom from AF/AFl  and freedom from MACCE. 

 Results: There was no in-hospital mortality. PVI did not significantly increase operative, cross-clamp, or cardiopulmonary bypass times (p=0.14, p=0.19, p=0.08). No major complications occurred. POAF incidence were: 40% (Group 1), 33.3% (II), 15.5% (III), and 4.8% (IV). While no significant differences were found between consecutive groups (I vs. II, p=0.41; II vs. III, p=0.23; III vs. IV, p=0.18), both PVI groups (III & IV) had significantly lower POAF than Group I (p=0.025 and p=0.003). At discharge, freedom from AF/AFl/AT/PT  were similar across all groups (95,5%; 97,6%; 97,6% and 95,5% in Groups 1 to 4 , respectively, p=0,21). At 36-month follow-up, cumulative  freedom from AF/AFl/AT/PT were 74.4%, 89.7%, 92.6%, and 81.9% in Groups I-IV, respectively. Cumulative freedom from MACCE were 91,5%, 94,5%, 98% and 98%.

Conclusions: Prophylactic PVI, alone or combined with amiodarone, significantly reduces new-onset AF after CABG without increasing procedural risk or complication rates.