Does Anterior Fat Pad Removal Reduce the Incidence of Atrial Fibrillation after CABG? A Meta-Analysis of Randomized Controlled Trials

Abstract

Anterior fat pad removal did not decrease the risk of the occurrence of AF after CABG despite its safety and convenience, and it should not be used to prevent new-onset AF after CABG unless new evidence is provided.

New-Onset Atrial Fibrillation in Adult Patients After Cardiac Surgery

“…Dissecting the epicardial fat pad to reveal an aortopulmonary window for aortic cannulation and cross-clamp placement is a routine step in cardiac surgery. Some authors have hypothesized that the disruption [103] or removal [104] of the anterior fat pad might be useful in decreasing AFACS. However, in a study of 55 patients undergoing CABG, the incidence of AFACS was significantly lower in the group randomized to anterior fat pad preservation than the group with anterior fat pad dissection (7% vs 37%, p < 0.01) [103].…”

“…Contradictory results from a study of 180 patients concluded that preserving the anterior fat pad did not reduce AFACS [105]. A 2015 meta-analysis that included 7 RCTs ( n = 991) concluded that the removal of the anterior fat pad did not lead to a decreased risk of AFACS, but did not examine the question of whether the converse was true—that is, whether preserving the fat pad would influence AFACS risk [104]. Further studies are required before a recommendation can be made about how surgical manipulation of the anterior fat pad might affect AFACS.…”

Pericardial Blood as a Trigger for Postoperative Atrial Fibrillation After Cardiac Surgery

“…The stimulation of these plexuses could create electrophysiologic modifications promoting POAF, such as shortened action potential and increased calcium transient in the atrial substrate [59,60]. Removing or preserving these fat pads does not reduce POAF [61]. However, ameliorating the inflammatory or vagal output of these fat pads does in fact reduce POAF [62,63].…”