B54-47 Posterior Pericardiotomy (PP) for the Prevention of Atrial Fibrillation in Post-Cardiac Surgery (POAF) Patients: A Narrative Review

Abstract Rationale Postoperative atrial fibrillation (POAF), defined as new-onset atrial fibrillation occurring after cardiac surgery which accounts for 10-65% of cases, with highest incidence typically occurring on second to third postoperative day. Risk of POAF is lowest in patients undergoing CABG and increases with valvular surgery and mixed cardiac procedures. The pathophysiology of POAF is complex, involving catecholamine surge, inflammatory response, atrial stretch, electrolyte imbalances, and postoperative pericardial effusion (PPE). By making an incision in the posterior pericardium and creating an opening in the left pleura to drain pericardial fluid, blood-induced irritation of the left atrium may be reduced. This abstract aims to discuss the advantages/disadvantages of posterior pericardiotomy (PP) in preventing POAF. Method A search was conducted using Google Scholar, PubMed, Cochrane, and Embase, yielding a total of 7,760 articles. After removing duplicates using Zotero and refining search criteria by reviewing abstracts, 977 articles were shortlisted. Inclusion criteria required articles be published in last five years, in English, and consisting of clinical trials, meta-analyses, and systematic reviews to enhance sample size and reduce heterogeneity. Studies involving patient populations greater than 500 and specifically examining posterior pericardiotomy for POAF prevention post-cardiac surgeries were included. Ultimately, seven articles (five systematic reviews and two randomized clinical trials) were selected. Results The findings indicated that PP significantly reduced incidence of POAF. Subgroup analysis comparing CABG to mixed surgeries revealed similar reductions in POAF rates. Additionally, PP group experienced 1) lower rates of supraventricular tachycardia, 2) lower early and late pericardial effusion, pericardial tamponade, and 3) shorter lengths of ICU stay compared to control group. However, pleural effusion was significantly more common in PP group. Studies showed no significant impact of revision surgery for bleeding, mortality, or ICU stay. Notably, impaired left ventricular diastolic dysfunction was more closely associated with POAF. Conclusion PP, in conjunction with prophylactic amiodarone, may decrease the incidence of POAF, potentially reducing the need for anticoagulants and related complications. However, heterogeneity among the PP and control groups exists, and confounding factors such as surgical approach, patient selection, and medication regimens should be considered when interpreting the findings. No randomized trial has directly compared PP with amiodarone to establish which is superior.Additionally, PP may reduce post-cardiac injury syndrome (PCIS) by alleviating postoperative pericardial effusion. PP has been shown to reduce POAF, regardless of whether a mediastinal drain is placed. The combination of PP and low-dose amiodarone may be preferred for preventing POAF. This abstract is funded by: none