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(Circulation. 2000;101:1403.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Atrial Fibrillation After Coronary Artery Bypass Surgery
A Model for Preoperative Risk Stratification
From the Department of Cardiology (A.G.Z.), University Hospital of Wales, Cardiff, Wales; the Cardiovascular Institute (G.H.), Mount Sinai Medical Center, New York, NY; the Department of Cardiology (R.A.A., N.P.C., P.G.M.), London Chest Hospital; and the Department of Environmental and Preventive Medicine (E.A.P.), St Bartholomew’s and The Royal London School of Medicine, London, UK.
Correspondence to Dr Zaman, Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14-4XN, UK. E-mail azfarzaman{at}hotmail.com
Background—Atrial fibrillation (AF) occurs in 20% to 40% of patients after CABG. Identification of patients vulnerable for arrhythmia will allow targeting of those most likely to benefit from prophylactic therapy. The aim of the present study was to evaluate accuracy of a prospectively defined signal-averaged P-wave duration (SAPD) cutoff and additional preoperative characteristics for the prediction of AF after CABG.
Methods and Results—Patients undergoing elective isolated CABG
were recruited to the present prospective study. SAPD was
recorded in all patients. Filtered signals from 3 orthogonal leads
were combined in a vector analysis, and total SAPD was measured
preoperatively. Postoperative in-hospital AF occurred in 92 (28.2%) of
326 patients. Patients who developed AF were older (65.9 versus 61.7
years of age; P<0.0005) and had longer SAPD (158 versus
145 ms; P<0.0005) than non-AF patients. Incidence of AF
increased in patients 
75 years of age and increased progressively
throughout the range of SAPD. Stepwise logistic regression
analysis of preoperative variables identified that SAPD
>155 ms (odds ratio, 5.37; 95% CI, 3.10 to 9.30;
P<0.0005), advanced age (odds ratio, 1.53; 95% CI,
1.26 to 1.86 per 5-year increase in age; P<0.0005), and
male sex (odds ratio, 2.88; 95% CI, 1.30 to 6.40;
P<0.01) independently predicted AF. Prospectively
defined SAPD >155 ms predicted AF with positive and negative
predictive accuracy of 49% and 84%, respectively.
Conclusions—A combination of prolonged SAPD, advanced age, and male sex identifies patients at high risk for development of AF after CABG.
Key Words: fibrillation • arrhythmia • surgery • men • sex • aging
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