Posterior pericardiotomy for the prevention of atrial fibrillation after coronary artery bypass grafting: A meta-analysis of randomized controlled trials

Background: Posterior pericardiotomy (PP) has been shown to be effective in patients after cardiac surgery complicated by a reduced the incidence of atrial fibrillation (AF). However, the role of PP in patients following coronary artery bypass graft (CABG) remains ambiguous. We aimed to systematically evaluate the efficacy of PP in preventing postoperative AF in adult patients after CABG. Methods: Studies were identified by searching multiple electronic databases (PubMed, Embase, and the Cochrane Library) through February, 2016, and by reviewing reference lists of obtained articles. The outcome measure was the incidence of postoperative AF. The meta-analysis was performed with the fixed-effect model or random-effect model according to heterogeneity. Results: Ten randomized trials incorporating 1648 patients were included in this meta-analysis (822 in the PP group and 826 in the control group). The cumulative incidence of AF was 10.6% in the PP group and 24.9% in the control group. Meta-analysis with all studies using a random-effects model suggested that PP had significant effect on the prevention of postoperative AF (I-2 55%; P < 0.00001; OR, 0.36; 95% CI, 0.23-0.56; RR, 0.45; 95% CI, 0.31-0.64). Sensitivity analyses by methodological quality and surgical technique yields similar results. Conclusions: This meta-analysis indicates that PP shows beneficial efficacy in preventing postoperative AF in adult patients after CABG. This finding encourages the use of PP to prevent postoperative AF after CABG, but, more high quality randomized controlled trials are still warranted to confirm the safety. (C) 2016 Elsevier Ireland Ltd. All rights reserved.