Gaudino M, Sanna T, Ballman KV, et al. - Given a possible role of pericardial effusion in induction of atrial fibrillation, the most common complication after cardiac surgery, researchers herein examined whether the incidence of atrial fibrillation after cardiac surgery can be lowered by performing posterior left pericardiotomy, a surgical maneuver that drains the pericardial space into the left pleural cavity.

• An adaptive, randomized, controlled trial was performed including 420 adult patients (aged ≥18 years) undergoing elective interventions on the coronary arteries, aortic valve, or ascending aorta, or a combination of these.

• Participants were randomly assigned to the posterior left pericardiotomy group (n = 212) or the no intervention group (n = 208; ITT population).

• Observations revealed significantly lower incidence of postoperative atrial fibrillation in the posterior left pericardiotomy group than in the no intervention group.

• Overall, posterior left pericardiotomy appeared highly effective in lowering 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.