Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery.

Steinberg, Jonathan S.; Zelenkofske, Steve; Wong, S. Chiu; Gelernt, Mark D.; Sciacca, Robert R.; Menchavez, E.

doi:10.1161/01.cir.88.6.2618

Cited by 263 publications

(144 citation statements)

References 16 publications

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“…Interestingly, the sensitivity and specificity were both similar to those obtained by STEINBERG, 1993 14 and KLEIN, 1995 15 for p wave duration measured by high resolution EKG. Among the four patients presenting with SACT longer than 96ms in this study, only one had documented post-operative AF.…”

Section: Discussionsupporting

confidence: 83%

Sinus node function in patients operated for mitral valve disease: indirect evaluation with epimyocardial electrodes

et al. 2008

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Purpose: To study the interatrial conduction times and atrial node performance in patients submitted to mitral valve surgery with the aid of temporary atrial epicardic electrodes. Methods: The atriograms were carried out in the first postoperative day and before the hospital discharge of ten consecutive patients. Results: Sixty percent of the patients could complete the post-operative study protocol. The main results were: a) Post-operative arrhythmias were detected in 50% of the patients; b) There were no statistical differences between the pre and post-operative 12 lead EKGs. c) The interatrial conduction time (IACT) ranged from 90 to 140ms in the first post-operative day, and from 110 to 130ms at hospital discharge; d) The sinus node recovery time (SNRT) ranged from 250 to 560 ms in the first post-operative day and from 180 to 360ms at hospital discharge; e) The sinus atrial conduction time (SACT) remained between 70 and 140ms, both in the first post-operative day and at hospital discharge, and; f) The IACT was normal in patients whose left atrium (LA) was less than 50mm in diameter but supra normal in the remaining cases. Conclusions: Sinus node function and inter-atrial conduction are not altered by mitral valve operation. Post-operative programmed epicardic atrial stimulation is easy and safe.Key words: Epicardial. Atriograms. Atrial Arrhythmias. Mitral Valve Disease. Cardiac Surgery. RESUMOObjetivo: Estudar os tempos de condução interatrial e a função do nó sinusal em pacientes submetidos a tratamento cirúrgico. Métodos: Foram estudados 10 pacientes adultos consecutivos submetidos à operação de correção de valvopatia mitral. Registraram-se atriogramas usando eletrodos epimiocárdicos cirurgicamente implantados. Os atriogramas foram obtidos no primeiro dia do pós-operatório e antes da alta hospitalar. Resultados: Os principais achados foram: a) A incidência de arritmias atriais até alta hospitalar foi de 50 %; b) O tempo de condução interatrial (TCIA) variou de 90 a 140 ms no 1°PO e 110 a130 ms antes da alta hospitalar; c) O tempo de recuperação do nó sinusal (TRNS) variou de 250 a 560 ms no 1°PO e180 a 360 ms antes da alta hospitalar; d) O tempo de condução sinoatrial (TCSA) variou de 70 a 140 ms tanto no 1ºPO, como antes da alta hospitalar e; d) O tempo de condução interatrial (TCIA) foi normal em pacientes com átrio esquerdo menores do que 50 mm e supranormal nos outros casos. Conclusão: As funções do nó sinusal e a condução interatrial não foram alteradas pelo tratamento cirúrgico da valvopatia mitral. A estimulação atrial epicárdica programada é segura de fácil realização.Descritores: Epicárdio. Atriogramas. Arritmias Atriais. Valvopatia Mitral. Cirurgia Cardíaca.

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Section: Discussionsupporting

confidence: 83%

Sinus node function in patients operated for mitral valve disease: indirect evaluation with epimyocardial electrodes

et al. 2008

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“…In previous studies, advanced age, male gender, chronic HF, preoperative AF attacks, COPD, chronic renal disease, DM and rheumatic heart disease, metabolic syndrome, obesity, and inefficient beta-blocker or ACE inhibitor use were reported to be preoperative clinical parameters predicting the development of POAF [12][13][14][15]. In addition to these parameters, p-wave duration on ECG and elevated levels of B-type natriuretic peptide in the preoperative period also predicted the development of POAF [22][23][24]. However, the predictive values of these parameters vary between the studies.…”

Section: Discussionmentioning

confidence: 93%

Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft

et al. 2016

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A b s t r a c tBackground: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is associated with increased morbidity and mortality. The HATCH score was originally devised to predict the progression of paroxysmal AF to persistent AF. Aim:To determine whether the HATCH score predicts the development of AF after CABG surgery. Methods:The medical records of 284 consecutive patients, who underwent CABG surgery between January 2013 and December 2014, were retrospectively reviewed for the development of AF in the postoperative (POAF) period. The HATCH score, and clinical and echocardiographic parameters were evaluated for all patients.Results: Seventy (25%) patients developed POAF. The HATCH scores were higher in the POAF group (2.8 ± 1.8 vs. 1.1 ± 1.2, p < 0.001). The area of the HATCH score under the curve in the receiver operating characteristics analysis was 773 (95% CI 706-841, p < 0.001). When the HATCH score was 2 or more as a threshold, there was for POAF 72% sensitivity and 75% specificity. Conclusions:The results of the present study suggest that the HATCH score can be used to predict the development of POAF.

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“…Echocardiographic intra-atrial and interatrial activation times, for example, correlate with ultrafiltration volume and shorten significantly toward the end of HD (47). Similarly, there are peridialytic changes in P-wave dispersion (standard electrocardiography), P-wave duration, and the root mean square voltage of the final 20 ms of the filtered P wave (signal-averaged electrocardiography)-parameters that measure atrial conduction delay and are associated with AF (48,49). In several studies, intradialytic changes were prominent and were attenuated at the conclusion of dialysis (50,51).…”

Section: Dialysis As a Triggermentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery.

Cited by 263 publications

References 16 publications

Sinus node function in patients operated for mitral valve disease: indirect evaluation with epimyocardial electrodes

Sinus node function in patients operated for mitral valve disease: indirect evaluation with epimyocardial electrodes

Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft

Arrhythmia and Sudden Death in Hemodialysis Patients

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