Effect of Posterior Pericardiotomy for the Prevention of Postoperative Atrial Fibrillation in Off-pump Coronary Artery Bypass Grafting

BackgroundThis randomized controlled trial was conducted to evaluate the impact of posterior pericardiotomy on the prevention of postoperative atrial fibrillation (POAF) in patients who underwent off-pump coronary artery bypass grafting (CABG). MethodsAdult patients who were scheduled to undergo isolated off-pump CABG were assessed for eligibility, and eligible patients were randomly assigned in a 1:1 manner to pericardiotomy or no intervention. Patients and postoperative caregivers were blinded to treatment assignment. The primary endpoint was the occurrence rate of POAF, and the secondary endpoints were the cumulative time spent in POAF and early outcomes, including operative mortality. ResultsA total of 403 patients were screened for eligibility, and 270 patients were randomly assigned to the posterior pericardiotomy group (n=136) or control group (n=134). The mean age was 67.8{+/-}10.3 years, and 20.4% (55 of 270 patients) were female. There was no intergroup difference in baseline characteristics or surgical data. Off-pump CABG was performed as planned in all patients except one. All patients received the assigned treatment regarding pericardiotomy, and no intergroup crossover occurred. POAF occurred in 27.8% (75 of 270 patients) of patients at a median of 2 days (interquartile range 1-3 days) after surgery. There was no significant difference in the occurrence rate of POAF between the two groups (30.1% and 25.4% in the pericardiotomy and control groups, P =.38). There were no significant differences in the secondary endpoints between the two groups. ConclusionsPosterior pericardiotomy does not reduce the occurrence rate of POAF in patients undergoing off-pump CABG. (NCT06159985)