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?

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

› Author Affiliations

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

References
1 Go AS, Hylek EM, Phillips KA. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285 (18) 2370-2375
2 Miyasaka Y, Barnes ME, Gersh BJ. et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114 (02) 119-125
3 Krijthe BP, Kunst A, Benjamin EJ. et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34 (35) 2746-2751
4 Chung MK, Refaat M, Shen WK. et al.; ACC Electrophysiology Section Leadership Council. Atrial fibrillation: JACC Council Perspectives. J Am Coll Cardiol 2020; 75 (14) 1689-1713
5 Boriani G, Laroche C, Diemberger I. et al. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 2015; 128 (05) 509-18.e2
6 Fauchier L, Villejoubert O, Clementy N. et al. Causes of death and influencing factors in patients with atrial fibrillation. Am J Med 2016; 129 (12) 1278-1287
7 Burrage PS, Low YH, Campbell NG, O'Brien B. New-onset atrial fibrillation in adult patients after cardiac surgery. Curr Anesthesiol Rep 2019; 9 (02) 174-193
8 Funk M, Richards SB, Desjardins J, Bebon C, Wilcox H. Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. Am J Crit Care 2003; 12 (05) 424-433 , quiz 434–435
9 Lee JK, Klein GJ, Krahn AD. et al. Rate-control versus conversion strategy in postoperative atrial fibrillation: a prospective, randomized pilot study. Am Heart J 2000; 140 (06) 871-877
10 Mathew JP, Fontes ML, Tudor IC. et al.; Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291 (14) 1720-1729
11 LaPar DJ, Speir AM, Crosby IK. et al.; Investigators for the Virginia Cardiac Surgery Quality Initiative. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thorac Surg 2014; 98 (02) 527-533 , discussion 533
12 Almassi GH, Wagner TH, Carr B. et al.; VA #517 Randomized On/Off Bypass (ROOBY) Study Group. Postoperative atrial fibrillation impacts on costs and one-year clinical outcomes: the Veterans Affairs Randomized On/Off Bypass Trial. Ann Thorac Surg 2015; 99 (01) 109-114
13 Kosmidou I, Chen S, Kappetein AP. et al. New-onset atrial fibrillation after PCI or CABG for left main disease: The EXCEL Trial. J Am Coll Cardiol 2018; 71 (07) 739-748
14 Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, Arnar DO, Gudbjartsson T. Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg 2012; 7: 87
15 Kuss O, Blettner M, Börgermann J. Propensity score: An alternative method of analyzing treatment effects. Dtsch Arztebl Int 2016; 113 (35-36): 597-603
16 Salah A, Zhou S, Liu Q, Yan H. P wave indices to predict atrial fibrillation recurrences post pulmonary vein isolation. Arq Bras Cardiol 2013; 101 (06) 519-527
17 Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015; 154: 13-20
18 Gaudino M, Di Franco A, Rong LQ. et al. Pericardial effusion provoking atrial fibrillation after cardiac surgery: JACC review topic of the week. J Am Coll Cardiol 2022; 79 (25) 2529-2539
19 Jennewein C, Tran N, Paulus P, Ellinghaus P, Eble JA, Zacharowski K. Novel aspects of fibrin(ogen) fragments during inflammation. Mol Med 2011; 17 (5-6): 568-573
20 St-Onge S, Perrault LP, Demers P. et al. Pericardial blood as a trigger for postoperative atrial fibrillation after cardiac surgery. Ann Thorac Surg 2018; 105 (01) 321-328
21 Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg 2009; 88 (06) 1871-1876
22 Lee SH, Kang DR, Uhm JS. et al. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft. Am Heart J 2014; 167 (04) 593-600.e1
23 Ahlsson A, Fengsrud E, Bodin L, Englund A. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. Eur J Cardiothorac Surg 2010; 37 (06) 1353-1359
24 Cameron MJ, Tran DTT, Abboud J, Newton EK, Rashidian H, Dupuis JY. Prospective external validation of three preoperative risk scores for prediction of new onset atrial fibrillation after cardiac surgery. Anesth Analg 2018; 126 (01) 33-38
25 Kawano S, Hiraoka M, Sawanobori T. Electrocardiographic features of P waves from patients with transient atrial fibrillation. Jpn Heart J 1988; 29 (01) 57-67
26 Dilaveris PE, Gialafos EJ, Sideris SK. et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135 (5 Pt 1): 733-738
27 Aytemir K, Ozer N, Atalar E. et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000; 23 (07) 1109-1112
28 Eranti A, Aro AL, Kerola T. et al. Prevalence and prognostic significance of abnormal P terminal force in lead V1 of the ECG in the general population. Circ Arrhythm Electrophysiol 2014; 7 (06) 1116-1121
29 Yoshizawa T, Niwano S, Niwano H. et al. Prediction of new onset atrial fibrillation through P wave analysis in 12 lead ECG. Int Heart J 2014; 55 (05) 422-427
30 Yıldırım E, Günay N, Bayam E, Keskin M, Ozturkeri B, Selcuk M. Relationship between paroxysmal atrial fibrillation and a novel electrocardiographic parameter P wave peak time. J Electrocardiol 2019; 57: 81-86
31 Park JK, Park J, Uhm JS, Joung B, Lee MH, Pak HN. Low P-wave amplitude (<0.1 mV) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Europace 2016; 18 (03) 384-391
32 Ciuffo L, Bruña V, Martínez-Sellés M. et al. Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography-magnetic resonance imaging correlation. J Cardiovasc Electrophysiol 2020; 31 (07) 1719-1725
33 German DM, Kabir MM, Dewland TA, Henrikson CA, Tereshchenko LG. Atrial Fibrillation Predictors: Importance of the Electrocardiogram. Ann Noninvasive Electrocardiol 2016; 21 (01) 20-29

Supplementary Material

Supplementary Material