Meta-analysis of randomized trials on the efficacy of posterior pericardiotomy in preventing atrial fibrillation after coronary artery bypass surgery

Objective: Posterior pericardiotomy is considered a method to reduce the incidence of atrial fibrillation after cardiac surgery. Its efficacy in preventing atrial fibrillation and supraventricular arrhythmias after coronary artery bypass surgery has been evaluated in the present meta-analysis. Methods: This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. Results: The search yielded 6 prospective, randomized studies reporting on postoperative atrial fibrillation in 763 patients after coronary artery bypass grafting. The cumulative incidence of atrial fibrillation was 10.8% in the posterior pericardiotomy group (PP group) and 28.1% in the control group (I-2 68%, random effect: P = .003; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.16-0.69). Supraventricular arrhythmias occurred in 13.8% of patients in the PP group and 35.4% in the control group (I-2 70%, random effect: P = .002; OR, 0.31; 95% CI, 0.15-0.65). Early pericardial effusion (6.9% vs 46.2%; I-2 67%; random effect: P < .0001; OR, 0.10; 95% CI, 0.04-0.28) and late pericardial effusion (0% vs 11.3%; I-2 0%; fixed effect: P = .0001; OR, 0.04; 95% CI, 0.01-0.21) were significantly less frequent in the PP group. Pleural effusion (5 studies included: 22.2% vs 17.1%; I-2 0%; fixed effect: P = .10; OR, 1.40; 95% CI, 0.94-2.08) and pulmonary complications were only slightly more frequent in the PP group (4 studies included: 3.6% vs 2.5%; I-2 0%; fixed effect: P.46; OR, 1.45; 95% CI, 0.54-3.86). Conclusions: Posterior pericardiotomy seems to significantly reduce the incidence of postoperative atrial fibrillation and supraventricular arrhythmias after coronary artery bypass grafting. The marked reduction of postoperative pericardial effusion after posterior pericardiotomy suggests that pericardial effusion is one of the main triggers involved in the development of atrial fibrillation after cardiac surgery. (J Thorac Cardiovasc Surg 2010; 139: 1158-61)