CompletedNot Applicable

Impact of Ligament of Marshall Resection on Atrial Fibrillation Occurrence in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Controlled Trial

Egypt220 participantsStarted 2024-01-11

Plain-language summary

Background: 20-40% of patients with ischemic heart disease managed with coronary artery bypass grafting (CABG) surgeries face the risk of postoperative atrial fibrillation (POAF), which is a known hazardous outcome. Being a well-known arrhythmogenic pathway, surgical excision of the ligament of Marshall may, theoretically, lower the incidence of POAF. Aim: In this study, we aimed to assess the safety and efficacy of prophylactic LoM resection in preventing POAF after on-pump CABG (ON-CAB.). Methods: 220 patients at elevated risk for POAF undergoing elective ON-CAB were randomized to receive either standard CABG alone (n = 110) or adjunctive LoM resection (n = 110) in this multicenter, randomized, assessor- and patient-blinded study with unblinded surgeons. ECG-verified POAF occurring within seven days was the primary outcome. Mortality, use of resources, and pharmaceutical therapy were secondary outcomes.

Who can participate

Age range18 Years

SexALL

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Inclusion Criteria: Adults aged ≥18 years. Scheduled for elective on-pump coronary artery bypass grafting (CABG). Diagnosed with multivessel coronary artery disease or left main disease requiring surgical revascularization according to current guidelines. Classified as high risk for postoperative atrial fibrillation, defined as the presence of at least two of the following: Age ≥65 years Left atrial enlargement (anteroposterior diameter \>40 mm on transthoracic echocardiography) History of paroxysmal atrial fibrillation not requiring long-term anticoagulation Chronic obstructive pulmonary disease requiring regular pharmacological therapy Ability to provide written informed consent. \*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\* Exclusion Criteria: Preoperative atrial fibrillation requiring active treatment or long-term anticoagulation. History of previous cardiac surgery. Severe left ventricular systolic dysfunction (ejection fraction \<30%). Emergency or urgent CABG. Concomitant cardiac procedures (e.g., valve surgery, surgical ablation for atrial fibrillation). Contraindications to anticoagulation or antiarrhythmic therapy. Inability or unwillingness to provide informed consent.

What they're measuring

Incidence of postoperative atrial fibrillation (POAF)

Timeframe: Within 7 days after coronary artery bypass grafting

Trial details

NCT IDNCT07492901

SponsorKasr El Aini Hospital

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2025-11-11