From the Departments of Anesthesiology, Medicine, and Surgery, Washington
University School of Medicine, St Louis, Mo.
Correspondence to Charles W. Hogue, Jr, MD, Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Ave, Box 8054, St Louis, MO 63110. E-mail hoguec{at}notes.wustl.edu
Background—Atrial
fibrillation/flutter (AF) is a frequent complication of
coronary artery bypass graft surgery (CABG) that leads to
increased costs and morbidity. We hypothesized that heart rate
variability (HRV), an indicator of cardiac sympathovagal balance, is
altered before the onset of postoperative AF. Because nonlinear methods
of HRV analysis provide information about heart rate dynamics
not evident from usual HRV measures, we also hypothesized that
approximate entropy (ApEn), a nonlinear measure of HRV, might have
predictive value.
Methods and Results—Analysis of HRV was performed in 3
sequential 20-minute intervals preceding the onset of postoperative AF
(24 episodes in 18 patients). These data were compared with
corresponding intervals in 18 sex- and age-matched postoperative
control subjects who did not develop AF. Patients had left
ventricular ejection fractions >45% before surgery and
were not receiving ß-blockers during ambulatory ECG monitoring after
surgery. Logistic regression demonstrated that on the basis of averaged
values for the three 20-minute intervals, increased heart rate and
decreased ApEn were independently associated with AF. Heart rate
dynamics before AF was associated with either lower (n=19) or higher
(n=5) RR interval variation by traditional measures of HRV or
quantitative Poincaré analysis, suggesting the
possibility of divergent autonomic conditions before AF onset.
Conclusions—In the hour before AF after CABG surgery, higher
heart rate and lower heart rate complexity compared with values in
control patients were independent predictors of AF. Decreased ApEn
occurs in patients with either increased or decreased HRV by
traditional measures and may provide a useful tool for risk
stratification or investigation of mechanisms.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery
Key Words: tachyarrhythmias • bypass • heart rate
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