Circulation, Vol 88, 2618-2622, Copyright © 1993 by American Heart Association
JS Steinberg, S Zelenkofske, SC Wong, M Gelernt, R Sciacca and E Menchavez
BACKGROUND. Atrial fibrillation (AF) is a commonly encountered arrhythmia
in clinical practice, and it occurs frequently after cardiac surgery. The
P-wave signal-averaged (SA) ECG noninvasively detects atrial conduction
delay. Prior studies have described greater P-wave prolongation in patients
with a history of AF, but prospective studies have not been performed.
METHODS AND RESULTS. Consecutive patients undergoing cardiac surgery were
enrolled. The P-wave SAECG was recorded before surgery from three
orthogonal leads using a sinus P-wave template and a cross-correlation
function. The averaged P wave was filtered with a least-squares-fit filter
and combined into a vector magnitude, and total P-wave duration was
measured. Patients were observed after cardiac surgery for the development
of AF. One hundred thirty patients were enrolled, and 33 (25%) developed AF
2.6 +/- 2.0 days after surgery. Patients with AF more often had left
ventricular hypertrophy on ECG (P < .05) and had a lower ejection
fraction (P < .05). The P-wave duration on the SAECG was significantly
longer in the AF patients than in those without AF: 152 +/- 18 versus 139
+/- 17 milliseconds (P < .001). An SAECG P-wave duration > 140
milliseconds predicted AF with sensitivity of 77%, specificity of 55%,
positive predictive accuracy of 37%, and negative predictive accuracy of
87%. The likelihood of experiencing AF was increased 3.9-fold if the SAECG
P- wave duration was prolonged. P-wave SAECG results were independent of
other clinical variables by multivariate analysis. CONCLUSIONS. The P- wave
duration recorded with the SAECG is a potent, accurate, and independent
predictor of AF after cardiac surgery.
ARTICLES
Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery
Department of Medicine, St Luke's/Roosevelt Hospital Center, New York, NY 10025.
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