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

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

Data Availability Statement

All relevant data are included in the manuscript and its supporting information files. If further original data underlying this article are requested, the corresponding author will share these upon a reasonable request.

Authors' Contribution

B.N. and S.R. contributed to the conception and design of the study, led the execution of the project, and held overall responsibility for all aspects of the work. S.R. and B.N. had a decisive and significant role and responsibility in the development of the revision and in the conception of the revision submitted here. C.R. has collected data and performed primary data analysis. S.R., B.N., C.R. contributed to conception and study design. S.R. B.N., C.R., M.S.D. contributed to intensively accompanying and shaping the evaluation and interpretation of the data. All authors contributed to critically revising and supervising all versions of the manuscript, approving the final version, and committing to uphold the integrity and accuracy of the work.

^* These authors contributed equally to this work and are listed as co-last authors.

Publication History

Received: 19 July 2024

Accepted: 17 May 2025

Accepted Manuscript online:
20 May 2025

Article published online:
17 June 2025

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