Jurij M Kališnik1, Viktor Avbelj2, Jon Vratanar3, Giuseppe Santarpino4, Borut Geršak3, Theodor Fischlein5, Roman Trobec6, Janez Žibert7. 1. Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia; Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg-Paracelsus Medical University, Nuremberg, Germany. Electronic address: Jurij.Kalisnik@klinikum-nuernberg.de. 2. Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia. Electronic address: viktor.avbelj@ijs.si. 3. Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia. 4. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg-Paracelsus Medical University, Nuremberg, Germany; Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy. 5. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg-Paracelsus Medical University, Nuremberg, Germany. Electronic address: Theodor.Fischlein@klinikum-nuernberg.de. 6. Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia. Electronic address: roman.trobec@ijs.si. 7. Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia. Electronic address: janez.zibert@zf.uni-lj.si.
Abstract
BACKGROUND: Changes in cardiac autonomic regulation and P-wave characteristics are associated with the occurrence of atrial fibrillation. The purpose of this study was to evaluate whether combined preoperative non-invasive determination of cardiac autonomic regulation and PR interval allows for the identification of patients at risk of new-onset atrial fibrillation after cardiac surgery. METHODS: RR, PR and QT intervals, and linear and non-linear heart rate variability parameters from 20 min high-resolution electrocardiographic recordings were determined one day before surgery in 150 patients on chronic beta blockers undergoing elective coronary artery bypass grafting, aortic valve replacement, or both, electively. RESULTS: Thirty-one patients (21%) developed postoperative atrial fibrillation. In the atrial fibrillation group, more arterial hypertension, a greater age, a higher EuroSCORE II, a higher heart rate variability index (pNN50: 9 ± 20 vs. 4 ± 10, p = 0.050), a short PR interval (156 ± 23 vs. 173 ± 31 ms; p = 0.011), and a reduced short-term scaling exponent of the detrended fluctuation analysis (DFA1, 0.96 ± 0.36 vs. 1.11 ± 0.30 ms; p = 0.032) were found compared to the sinus rhythm group. Logistic regression modeling confirmed PR interval, DFA1 and age as the strongest preoperative predictors of postoperative atrial fibrillation (area under the receiver operating characteristic curve = 0.804). CONCLUSIONS: Patients developing atrial fibrillation after cardiac surgery presented with severe cardiac autonomic derangement and a short PR interval preoperatively. The observed state characterizes both altered heart rate regulation and arrhythmic substrate and is strongly related to an increased risk of postoperative atrial fibrillation.
BACKGROUND: Changes in cardiac autonomic regulation and P-wave characteristics are associated with the occurrence of atrial fibrillation. The purpose of this study was to evaluate whether combined preoperative non-invasive determination of cardiac autonomic regulation and PR interval allows for the identification of patients at risk of new-onset atrial fibrillation after cardiac surgery. METHODS: RR, PR and QT intervals, and linear and non-linear heart rate variability parameters from 20 min high-resolution electrocardiographic recordings were determined one day before surgery in 150 patients on chronic beta blockers undergoing elective coronary artery bypass grafting, aortic valve replacement, or both, electively. RESULTS: Thirty-one patients (21%) developed postoperative atrial fibrillation. In the atrial fibrillation group, more arterial hypertension, a greater age, a higher EuroSCORE II, a higher heart rate variability index (pNN50: 9 ± 20 vs. 4 ± 10, p = 0.050), a short PR interval (156 ± 23 vs. 173 ± 31 ms; p = 0.011), and a reduced short-term scaling exponent of the detrended fluctuation analysis (DFA1, 0.96 ± 0.36 vs. 1.11 ± 0.30 ms; p = 0.032) were found compared to the sinus rhythm group. Logistic regression modeling confirmed PR interval, DFA1 and age as the strongest preoperative predictors of postoperative atrial fibrillation (area under the receiver operating characteristic curve = 0.804). CONCLUSIONS:Patients developing atrial fibrillation after cardiac surgery presented with severe cardiac autonomic derangement and a short PR interval preoperatively. The observed state characterizes both altered heart rate regulation and arrhythmic substrate and is strongly related to an increased risk of postoperative atrial fibrillation.
Authors: Sven Geurts; Martijn J Tilly; Banafsheh Arshi; Bruno H C Stricker; Jan A Kors; Jaap W Deckers; Natasja M S de Groot; M Arfan Ikram; Maryam Kavousi Journal: Clin Res Cardiol Date: 2022-08-13 Impact factor: 6.138
Authors: Ondřej Toman; Katerina Hnatkova; Peter Smetana; Katharina M Huster; Martina Šišáková; Petra Barthel; Tomáš Novotný; Georg Schmidt; Marek Malik Journal: Sci Rep Date: 2020-02-13 Impact factor: 4.379
Authors: Michal J Kawczynski; Sophie Van De Walle; Bart Maesen; Aaron Isaacs; Stef Zeemering; Ben Hermans; Kevin Vernooy; Jos G Maessen; Ulrich Schotten; Elham Bidar Journal: Interact Cardiovasc Thorac Surg Date: 2022-09-09