Value of the P-wave signal averaging electrocardiogram for predicting atrial fibrillation in early and long period after coronary artery bypass surgery

Introduction. Atrial fibrillation (AF) occurs commonly after coronary artery bypass surgery(CABG).Signal average dP-w ave ECG (A-SAECG) has been used to assess the risk of paroxysmal atrial fibrillation.The aim of this study was to define the clinical value of prolonged P-wave durationon A-SAECG for the prediction of atrial fibrillation after coronary artery bypass surgery. Materials and methods: 170 consecutive patients undergoing isolated CABG were enrolled to the study. Signal averaged ECG was recorded in all patients 1-14 days before CABG. Filtered P wave triggered QRS complex averaging at noise level <0.3 μV was analyzed. Information on their clinical surgical, and hemodynamic characteristics as well as hospital course was also collected. Results: During a follow-up period of up to 360 days, 28 patients (17%) developed AF 2,4+2.5 days (range 1 to 8 days) after surgery. Patients who developed AF were significantly older (60.1vs.57.6years, P<0.001). P wave duration on SAECG was significantly longer in group with postoperative AF (130+11 vs. 116+10 ms). Stepwise logistic regression analysis of preoperative variables identified that only prolonged P wave duration > 125ms (OR 4,23; 95% CI, 1,13-12,6; p<0,0001) independently predicted early postoperative AF. Prospectively defined P wave duration on SAECG >125 ms predicted AF with positive of 57% and negative predictive value of 93%, respectively. Conclusions: Prolonged P wave duration on SAECG >125 ms and combination of prolonged P wave duration >125 ms and age > 60 years good identifies patients at high risk for development of AF early after CABG.(Clin. Exp. Med. Lett. 2006; 47(2):105-108)

Keywords: Atrial Fibrillation, Arrhythmia, Surgery, PwavesignalaveragedECG