Signal-averaged P-wave duration does not predict atrial fibrillation after thoracic surgery Journal Article


Authors: Amar, D.; Roistacher, N.; Zhang, H.; Baum, M. S.; Ginsburg, I.; Steinberg, J. S.
Article Title: Signal-averaged P-wave duration does not predict atrial fibrillation after thoracic surgery
Abstract: Background: Atrial fibrillation (AF) is the most common dysrhythmia seen early after major thoracic surgery but occurs infrequently after minor thoracic or other operations. A prolonged signal-averaged P-wave duration (SAPWD) has been shown to be an independent predictor of AF after cardiac surgery. The authors sought to determine whether a prolonged SAPWD alone or in combination with clinical or echocardiographic correlates predicts AF after elective noncardiac thoracic surgery. Methods: Of the 250 patients enrolled 228 were included in the final analysis. Preoperative SAPWD was obtained in 155 patients who had major thoracic surgery and in 73 patients undergoing minor thoracic or other operations who served as comparison control subjects. The SAPWD was recorded from three orthogonal leads using a sinus P-wave template. The filtered vector composite was used to measure total P-wave duration. Clinical, surgical, and echocardiographic parameters were collected and patients followed for 30 days after surgery for the development of symptomatic AF. Results: Symptomatic AF developed in 18 of 155 (12%) patients undergoing major thoracic surgery and in 1 of 73 (1%) patients having minor thoracic or abdominal surgery, most commonly 2 or 3 days after surgery. In comparison with similar patients undergoing major thoracic surgery without AF, those who developed AF were older(66 +/- 8 vs. 62 +/- 10 yr; P = 0.04) but did not differ in SAPWD (145 +/- 17 vs. 147 +/- 16, ms) in standard electrocardiographic P-wave duration (105 +/- 7 vs. 107 +/- 10 ms), incidence of left-ventricular hypertrophy on 12-lead electrocardiographic, male sex, history of hypertension, diabetes, or coronary heart disease. Thoracic-surgery patients at risk for postoperative AF did not differ from all other patients at low risk for AF in clinical or SAPWD parameters. Conclusions: Under the conditions of this study, SAPWD did not differentiate patients who did or did not develop AF after noncardiac thoracic surgery, and therefore its measurement cannot be recommended for the routine evaluation of these patients. Older age continues to be a risk factor for AF after thoracic surgery.
Keywords: reproducibility; risk; electrocardiography; disease; system; arrhythmias; symptomatic tachydysrhythmias; ecg; signal-avenged electrocardiogram
Journal Title: Anesthesiology
Volume: 91
Issue: 1
ISSN: 0003-3022
Publisher: Lippincott Williams & Wilkins  
Date Published: 1999-07-01
Start Page: 16
End Page: 23
Language: English
ACCESSION: WOS:000081188400006
DOI: 10.1097/00000542-199907000-00007
PROVIDER: wos
PUBMED: 10422924
Notes: Article; Proceedings Paper -- Presented in part at the 46th Annual Meeting of the American College of Cardiology that took place March 16-19, 1997 in Anaheim, CA -- Source: Wos
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  1. Hao Zhang
    54 Zhang