Effect of atrial pacing on post-operative atrial fibrillation following coronary artery bypass grafting: Pairwise and network meta-analyses

To determine the effect of atrial pacing on the rate of post-operative atrial fibrillation (POAF) following coronary artery bypass grafting. After a systematic literature search, randomized clinical trials (RCTs) comparing any combination of no pacing (NP), bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA) pacing were included. Pairwise and network meta-analyses were performed using the generic inverse variance method. The primary outcome was POAF incidence. Secondary outcomes were postoperative bleeding, infection, and operative mortality. Leave-one-out and meta-regression were done. Fourteen RCTs were included with a total of 1727 patients. Compared with NP, any form of atrial pacing was significantly associated with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.35–0.69). BiA pacing was associated with the larger risk reduction (OR: 0.36; 95% CI: 0.20–0.64 vs. 0.59; 95% CI: 0.34–1.02 for LA and 0.64; 95% CI: 0.38–1.07 for RA). Secondary outcomes were similar between the no pacing and pacing groups. On meta-regression, age and the use of continuous monitoring were associated with lower reduction of the incidence of POAF. In the network meta-analysis, BiA pacing ranked the best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21–0.55). Compared to other pacing modalities, BiA pacing is associated with lower rates of POAF following CABG. •POAF is common following CABG.•Compared to other pacing modalities, BiA pacing reduces the incidence of POAF following CABG.•Age and the use of continuous monitoring were associated with lower reduction of the incidence of POAF.