Right atrial overdrive pacing does not prevent atrial fibrillation after coronary artery bypass surgery.

AIMS: The purpose of this prospective randomized study was to investigate the efficacy of atrial overdrive pacing (AOP) and bradycardia prevention pacing (BPP) in the prophylaxis of atrial fibrillation (AF) after coronary artery bypass surgery (CABG). METHODS: One hundred and twenty-four on-pump CABG patients were randomized into three groups: AOP, BPP, and NP (no pacing). AOP patients were paced via epicardial wires using an atrial preference pacing algorithm, and BPP patients were paced in the AAI mode with a base rate of 60/min. Patients were paced for 48 h starting on the first postoperative day. The endpoint of the study was the first onset of AF lasting longer than 5 min. RESULTS: Preoperative risk factors and surgical data of patients did not differ between the AOP, BPP and NP groups. Pacing was technically successful in 80.5% of patients in the AOP and in 92.7% in the BPP groups. The incidence of AF in the AOP (26.8%), BPP (19.5%) and NP (28.6%) groups did not differ significantly. In the AOP group, AF in three patients was probably induced by inappropriate pacing due to sensing failure. CONCLUSIONS: Atrial overdrive pacing and bradycardia prevention pacing were not effective in the prevention of AF after CABG.

Infrainguinal revascularization because of claudication: total long-term outcome of endovascular and surgical treatment.

OBJECTIVE: This study was undertaken to define total long-term outcome achievable with invasive treatment, ie, endovascular or surgical, in patients with claudication with infrainguinal lesions. Priority in primary treatment was given to percutaneous transluminal angioplasty. METHODS: Data were analyzed for 233 consecutive patients with claudication in whom primary infrainguinal revascularization was performed in 304 limbs between 1989 and 1992. Patients were followed-up to May 2001 (mean, 81 months). Treatment included primary endovascular therapy when applicable (n = 272 limbs) or primary surgical treatment (n = 32; 10.5%). Type of further revascularization, if required, was selected on an individual basis for each patient. All procedures performed because of limb ischemia were recorded. Clinical outcome at the end of follow-up was compared with the preoperative condition. Cumulative primary, secondary, and total patency rates and development of chronic critical ischemia (CCI) were defined. Total patency reflects the ultimate achievable benefit of invasive treatment and refers to patency maintained at the primarily treated segment by means of any invasive (endovascular or surgical) therapy, including potential crossover to another treatment group. RESULTS: A mean of 2 (median, 1) operations per limb were performed during follow-up. No additional operations were needed in 50.3% (n = 153) of limbs. Fontaine classification at the end of the study was better compared with the preoperative value (P <.0005). Crossover between endovascular and surgical treatment was recorded in 21.1% (n = 64) of limbs. At 5 years, primary, secondary, and total patency rates (plus or minus standard error of estimate [SEE]) were 27% +/- 3%, 45% +/- 3%, and 61% +/- 3%, respectively, and at 10 years these rates were 16% +/- 3%, 27% +/- 3%, and 41% +/- 3%. CCI developed in 37 limbs (12.2%), of which 15 (41%) had been treated with endovascular methods only. Type II diabetes and hypertension were statistically significant predictors of increased risk for CCI. CONCLUSION: Combining endovascular and surgical methods when necessary improved total outcome of invasive infrainguinal treatment of claudication. Crossover between endovascular and surgical treatment was required in 21% of limbs over the long term.

Long-term outcome of patients with claudication after balloon angioplasty of the femoropopliteal arteries.

PURPOSE: To report the long-term outcome of patients with lifestyle-limiting claudication after percutaneous transluminal angioplasty (PTA) of the femoropopliteal arteries. MATERIALS AND METHODS: Between 1989 and 1992, 173 consecutive claudicant patients (mean age, 65 years; age range, 41-90 years) underwent PTA in 218 limbs; all interventions included femoral and/or popliteal arterial segments, and additional iliac (n = 27) and infrapopliteal (n = 11) arterial lesions were also treated. Patients were followed up for 7-10 years. Altogether, 37 (17%) limbs were classified as Fontaine class 2A, and 181 (83%) were class 2B. Average length of the primary lesion was 5.2 cm. Reinterventions were analyzed. Patency rates and patient survival were assessed by means of life table analysis. Cox-Mantel tests and Cox proportional hazards models were used to define associated independent determinants. Development of chronic critical ischemia (CCI) and its determinants was assessed by using the Pearson chi(2) test and multiple logistic regression analysis. RESULTS: The primary and secondary patencies (+/- standard error of the estimate), respectively, were 46% +/- 3 and 63% +/- 3 at 1 year, 25% +/- 3 and 41% +/- 4 at 5 years, and 14% +/- 3 and 22% +/- 4 at 10 years. One-third (71 of 218) of the limbs required repeat interventions, including surgical revascularization in 35 limbs. Fourteen (6.4%) limbs developed CCI, resulting in a 0.8% incidence per year. In multivariate analysis, poor postinterventional peripheral runoff was an indicator of increased risk of CCI development (P =.03). CONCLUSION: Although the long-term patency rates of PTA of the femoropopliteal arteries in claudicant patients were poor, the acceptable number of reinterventions and the low frequency of development of CCI imply the long-term benefits achievable with this treatment.