Posterior left pericardiotomy for the prevention of atrial fibrillation during cardiac surgery seems to significantly reduce atrial fibrillation risk (AF) after procedure.

The procedure consists of a 4-5 cm incision in the posterior pericardium to allow drainage of fluids and thrombi from the pericardium to the pleural cavity during postoperative period. 

Patients receiving the incision during surgery to coronary arteries, aortic valve, or ascending aorta showed a significantly lower rate of postoperative AF (17% vs 32%; RR 0.55; 95% CI 0.39-0.78), with no increase in perioperative complications.

The PALACS randomized 420 patients to receiving or not posterior left pericardiotomy as part of their surgery.  

Seeing as atrial fibrillation is one of the most frequent postoperative complication, this study should by confirmed in a large multicenter study. The PALACS was limited by the single-center design, and the fact that it was not powered to detect differences in clinical events. 

Original Title: Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial.

Reference: Mario Gaudino et al. Presentado en las sesiones científicas del AHA 2021 y publicado simultáneamente en Lancet. 2021 Nov 12;S0140-6736(21)02490-9. Online ahead of print. doi: 10.1016/S0140-6736(21)02490-9. 

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