Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?

Christian Rau; Miriam Salzmann-Djufri; Andreas Böning; Susanne Rohrbach; Bernd Niemann

doi:10.1055/a-2616-3919

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg
DOI: 10.1055/a-2616-3919

Original Cardiovascular

Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?

Authors

Christian Rau

¹Klinik für Herz-, Kinderherz- und Gefäßchirurgie, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-Universität Giessen, Giessen, Hessen, Germany
Miriam Salzmann-Djufri

²Klinik für Herz-, Kinderherz- und Gefäßchirurgie, UKGM, Giessen, Hessen, Germany
Andreas Böning

³Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
Susanne Rohrbach^*

⁴Physiologisches Institut, Justus-Liebig-Universitat Giessen, Giessen, Hessen, Germany
Bernd Niemann^*

¹Klinik für Herz-, Kinderherz- und Gefäßchirurgie, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-Universität Giessen, Giessen, Hessen, Germany

Abstract

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Abstract

Objectives

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.

Methods

We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score-matched cohorts (POAF vs. sinus rhythm [SR]), ECGs were evaluated regarding P-wave duration (PWD), amplitude (PWA), morphology, variability, and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding the development of manifest AF after POAF was analyzed.

Results

Of 212 patients included, 50 patients (23.6%) developed POAF. Ninety patients underwent propensity score matching (PSM), 64 (71%) participated in follow-up, 21 (23%) died prior to follow-up (POAF: 13 vs. SR: 8), and 5 (6%) withdrew consent. No patient developed persistent AF. In nine patients, paroxysmal AF (pAF) events were detected (POAF: 6 vs. SR: 3). PWD, P-dispersion (PD), PWA, and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, PD and P-wave peak time (PWPT) increased, and P-amplitude decreased in these. Preoperative β-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients.

Conclusion

Patients with POAF are prone to episodes of pAF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.

Keywords

atrial fibrillation - outcomes (includes mortality, morbidity) - surgery - complications

Full Text

References

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