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J Cardiothorac Vasc Anesth. 2014 Dec;28(6):1497-504. doi: 10.1053/j.jvca.2014.04.034. Epub 2014 Sep 26.

P-wave characteristics on routine preoperative electrocardiogram improve prediction of new-onset postoperative atrial fibrillation in cardiac surgery.

Author information

1
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA. Electronic address: wongjk2003@gmail.com.
2
Department of Anesthesia, Cedars Sinai Medical Center, Los Angeles, CA.
3
Department of Cardiology, Stanford University School of Medicine, Stanford, CA.
4
Department of Anesthesia, Johns Hopkins University, Baltimore, MD.
5
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.

Abstract

OBJECTIVE:

To test the hypothesis that including preoperative electrocardiogram (ECG) characteristics with clinical variables significantly improves the new-onset postoperative atrial fibrillation prediction model.

DESIGN:

Retrospective analysis.

SETTING:

Single-center university hospital.

PARTICIPANTS:

Five hundred twenty-six patients, ≥ 18 years of age, who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement/repair, or a combination of valve surgery and coronary artery bypass grafting requiring cardiopulmonary bypass.

INTERVENTIONS:

Retrospective review of medical records.

MEASUREMENTS AND MAIN RESULTS:

Baseline characteristics and cardiopulmonary bypass times were collected. Digitally-measured timing and voltages from preoperative electrocardiograms were extracted. Postoperative atrial fibrillation was defined as atrial fibrillation requiring therapeutic intervention. Two hundred eight (39.5%) patients developed postoperative atrial fibrillation. Clinical predictors were age, ejection fraction<55%, history of atrial fibrillation, history of cerebral vascular event, and valvular surgery. Three ECG parameters associated with postoperative atrial fibrillation were observed: Premature atrial contraction, p-wave index, and p-frontal axis. Adding electrocardiogram variables to the prediction model with only clinical predictors significantly improved the area under the receiver operating characteristic curve, from 0.71 to 0.78 (p<0.01). Overall net reclassification improvement was 0.059 (p = 0.09). Among those who developed postoperative atrial fibrillation, the net reclassification improvement was 0.063 (p = 0.03).

CONCLUSION:

Several p-wave characteristics are independently associated with postoperative atrial fibrillation. Addition of these parameters improves the postoperative atrial fibrillation prediction model.

KEYWORDS:

cardiac surgery; electrocardiogram; p-wave characteristics; postoperative atrial fibrillation

PMID:
25263779
DOI:
10.1053/j.jvca.2014.04.034
[Indexed for MEDLINE]
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