Fragmented QRS complexes are associated with postoperative atrial fibrillation development after coronary artery bypass grafting surgery

Abstract

Objective Postoperative atrial fibrillation (PoAF) is one of the most frequent complications and a major risk factor of morbidity and mortality after coronary artery bypass grafting (CABG). Fragmented QRS complex (fQRS) on a 12-lead surface ECG is recently gained increasing attention as a simplified noninvasive ECG marker with diagnostic and prognostic value in various cardiac conditions. The aim of the present study was to evaluate the association between development of PoAF and presence of fQRS on admission ECG in patients undergoing CABG surgery. Methods A total of 242 patients who underwent CABG between February 2016 and June 2018 were included in this study. The patients were divided into two groups as developing and nondeveloping PoAF groups in the postoperative period. fQRS was defined as the presence of various RSR′ patterns including an additional R wave, notching of the R or S waves, or the presence of more than one fragmentation in two contiguous leads. Results In-hospital mortality was higher in PoAF (+) group compared to PoAF (–) group (20.5 vs. 6.4%, P = 0.004). PoAF rate was higher in fQRS (+) group than fQRS (–) group (25.3 vs. 9.8%, P = 0.001). In multivariate analysis, the presence of fQRS complexes on admission ECG [odds ratio (OR) 2.801, 95% confidence interval (CI) 1.262–6.211, P = 0.011) and hemoglobin (OR 0.794; 95% CI, 0.641–0.985; P = 0.036) were identified as independent predictors of PoAF after CABG surgery. Conclusion The presence of fQRS on admission ECG was found to be an independent predictor of PoAF in patients undergoing isolated CABG.

Optimising risk factors for atrial fibrillation post-cardiac surgery

“…Electrocardiogram (ECG), is the standard preoperative investigation for cardiac patients. 53 Preoperative ECG abnormalities associated with an increased risk of POAF include fragmented QRS complexes, abnormal heart rate turbulence (representative of autonomic dysfunction), and prolonged P-waves(⩾105 ms) and QRS complexes (Table 1). [53][54][55][56][57] The echocardiogram allows preoperative assessment of cardiac anatomy and valvular and haemodynamic function.…”

“…53 Preoperative ECG abnormalities associated with an increased risk of POAF include fragmented QRS complexes, abnormal heart rate turbulence (representative of autonomic dysfunction), and prolonged P-waves(⩾105 ms) and QRS complexes (Table 1). [53][54][55][56][57] The echocardiogram allows preoperative assessment of cardiac anatomy and valvular and haemodynamic function. 58 Functional abnormalities, such as ejection fraction (EF) <40% and diastolic dysfunction (Table 1) have been associated with an increased risk of POAF.…”

The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: A 24‐months follow‐up study

“…It has also been closely associated with the in‐depth study of fragmented QRS 15,16,41,42 . fQRS has important clinical significance as it can improve the diagnosis rate of prior MI and can be used as an early warning of high‐risk patients with MI 30,31,42 …”

“…fQRS was also reported as a significant independent predictor for cardiac events and cardiac mortality in NSTEMI patients 29 . Recent studies by Kurtul et al 30,31 found that fQRS was an independent predictor of postprocedural contrast‐induced nephropathy and in‐hospital mortality in STEMI patients. Moreover, fQRS could predict the development of postoperative atrial fibrillation (PoAF) in patients undergoing coronary artery bypass grafting (CABG) surgery.…”

Effect of del nido cardioplegia use on kidney injury after coronary bypass operations

“…Among atherosclerotic cardiovascular diseases, coronary artery disease (CAD) is especially important. In its treatment, coronary artery bypass grafting (CABG) surgery can be successfully performed in conjunction with cardiopulmonary bypass (CPB) thanks to the developing extracorporeal circulation systems 1 . However, the use of these systems brings about the risk of various complications because of activated inflammatory pathways due to the contact of blood with foreign external surfaces.…”