Postoperative atrial fibrillation is a common complication of cardiac surgery and increases the risk of mortality, stroke, morbidity, and extended stay in hospital. 1 Hindricks G Potpara T Dagres N et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42: 373-498 Crossref PubMed Scopus (2081) Google Scholar , 2 Greenberg JW Lancaster TS Schuessler RB Melby SJ Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017; 52: 665-672 Crossref PubMed Scopus (125) Google Scholar , 3 Arsenault KA Yusuf AM Crystal E et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013; 2013CD003611 Google Scholar Although other researchers have shown, mostly in small studies and meta-analyses, 4 Gozdek M Pawliszak W Hagner W et al. Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery. J Thorac Cardiovasc Surg. 2017; 153: 865-875.e12 Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar that this simple surgical procedure reduces the risk of cardiac tamponade, a randomised comparison between posterior left pericardiotomy and standard of care, with postoperative atrial fibrillation as a primary outcome measure, had not been performed until now. 5 Abouarab AA Leonard JR Ohmes LB et al. Posterior left pericardiotomy for the prevention of postoperative Atrial fibrillation after Cardiac Surgery (PALACS): study protocol for a randomized controlled trial. Trials. 2017; 18: 593 Crossref PubMed Scopus (9) Google Scholar In The Lancet, Mario Gaudino and colleagues 6 Gaudino M Sanna T Ballman KV et al. Posterior left pericardiectomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial. Lancet. 2021; (published online Nov 14.)https://doi.org/10.1016/S0140-6736(21)02490-9 Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar report their randomised controlled trial investigating this procedure to fill this knowledge gap. Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trialPosterior left pericardiotomy is highly effective in reducing the incidence of atrial fibrillation after surgery on the coronary arteries, aortic valve, or ascending aorta, or a combination of these without additional risk of postoperative complications. Full-Text PDF
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