VALUE OF THE P-WAVE SIGNAL-AVERAGED ECG FOR PREDICTING ATRIAL-FIBRILLATION AFTER CARDIAC-SURGERY

Citation
Js. Steinberg et al., VALUE OF THE P-WAVE SIGNAL-AVERAGED ECG FOR PREDICTING ATRIAL-FIBRILLATION AFTER CARDIAC-SURGERY, Circulation, 88(6), 1993, pp. 2618-2622
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2618 - 2622
Database
ISI
SICI code
0009-7322(1993)88:6<2618:VOTPSE>2.0.ZU;2-8
Abstract
Background. Atrial fibrillation (AF) is a commonly encountered arrhyth mia in clinical practice, and it occurs frequently after cardiac surge ry. The P-wave signal-averaged (SA) ECG noninvasively detects atrial c onduction delay. Prior studies have described greater P-wave prolongat ion in patients with a history of AF, but prospective studies have not been performed. Methods and Results. Consecutive patients undergoing cardiac surgery were enrolled. The P-wave SAECG was recorded before su rgery from three orthogonal leads using a sinus P-wave template and a cross-correlation function. The averaged P wave was filtered with a le ast-squares fit filter and combined into a vector magnitude, and total P-wave duration was measured. Patients were observed after cardiac su rgery for the development of AF. One hundred thirty patients were enro lled, and 33 (25%) developed AF 2.6+/-2.0 days after surgery. Patients with AF more often had left ventricular hypertrophy on ECG (P<.05) an d had a lower ejection fraction (P<.05). The P-wave duration on the SA ECG was significantly longer in the AF patients than in those without AF: 152+/-18 versus 139+/-17 milliseconds (P<.001). An SAECG P-wave du ration >140 milliseconds predicted AB with sensitivity of 77%, specifi city of 55%, positive predictive accuracy of 37%, and negative predict ive accuracy of 87%. The likelihood of experiencing AF was increased 3 .9-fold if the SAECG P-wave duration was prolonged. P-wave SAECG resul ts were independent of other clinical variables by multivariate analys is. Conclusions. The P-wave duration recorded with the SAECG is a pote nt, accurate, and independent predictor of AF after cardiac surgery.