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1School
Preoperative P-wave predicts of atrial fibrillation after coronary artery bypass
graft: results from Beijing China and a combination of meta-analysis
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Title of the Research Study
FQ
1
Wu ,
Y
1
Wu ,
WY
1
Tao ,
HB
2
Zhao ,
HY
2
Zhang ,
DY
3
Shen
PEOPLE WHO DID THE STUDY
of Nursing, Capital Medical University, China; 2 Heart Center, Beijing Chao Yang Hospital Affiliated to Capital Medical University,
3
UNIVERSITIES
AND/OR
HOSPITALS
THEY
ARE
AFFILIATED
China; Heart
Center,
Beijing Jian
Gong
Hospital,
China WITH
BACKGROUND
 The onset of postoperative AF (POAF) can result in an increased
morbidity, a prolonged ICU and hospital stay, and higher costs.
 The meta-analysis combined our study with 10 other similar studies
with a total of 3,207 patients. Overall, prolonged POPWD was
associated with greater risk of POAF, with a weighted mean
difference of 4.76 ms (95% CI 2.62 to 6.90, P < 0.001). Although there
was significant heterogeneity across the studies, after performing
several sensitivity and subgroup analyses, this was not a significant
influence on the results (Figure 2).
 It is important to identify patients at high risk of developing POAF
so that targeted prophylactic therapy can be given.
 Patients who developed POAF had more unfavorable in-hospital
outcomes (Table 1).
 Atrial fibrillation (AF) occurs in 20% to 40% of patients after
coronary artery bypass grafting (CABG).
 Preoperative P-wave duration (POPWD) has been suggested to be
predictive of POAF. It is still controversial, however, regarding
how well POPWD predicts POAF.
OBJECTIVE
We set out to examine the value of POPWD in predicting POAF
among other characteristics and combined our results with others in a
meta-analysis.
METHODS
 We prospectively studied 263 consecutive patients with normal
sinus rhythm (NSR) undergoing first-time elective isolated CABG.
12-lead electrocardiogram was obtained preoperatively. Patients'
demographic, clinical and surgical characteristics were collected
prospectively.
 The main endpoint was the occurrence of first AF lasting > 5 min.
The patients were classified as either NSR or AF according to their
postoperative rhythm, which was continuously monitored for the
first 7 postoperative days.
 POPWD was analyzed with a commercial software by a research
member who was blinded to the patients' classification.
 Explanatory variables with P < 0.1 upon univariate analysis were
entered into the logistic regression model to assess the independent
predictors of POAF. In addition, we performed a meta-analysis to
assess the combined effect of POPWD in predicting POAF.
RESULTS
 Of the 263 patients, 85 (32.3%) developed AF at 2.30±1.45 days
after CABG and 80 patients (94.1%) had AF within 4 days
following CABG (Figure 1).
 Patient characteristics and surgical data are presented in Table 1.
Table 1. Patient characteristics and in-hospital outcomes
Characteristics
Preoperative
Mean age (years)
Males, n (%)
Mean BMI (kg/m2)
Hypertension, n (%)
Diabetes mellitus, n (%)
COPD, n (%)
Myocardial infarction, n (%)
Peripheral vascular disease, n (%)
Cerebrovascular disease, n (%)
Left atrial diameter (mm)
LVEF (%)
Aotic regurgitation, n (%)
Mitral regurgitation, n (%)
P-wave duration (ms)
P-wave duration > 105ms, n (%)
Triple vessel disease, n (%)
RCA disease, n (%)
β-Blocker use , n (%)
Statin use , n (%)
ACEI or ARB use, n (%)
Intraoperative
Mean grafts
Duration of surgery (hrs)
With AF (n = 85) With SR (n = 178)
66.1 ± 8.0
57 (67.1%)
25.4 ± 3.4
69 (81.2%)
25 (29.4%)
4 (4.7%)
48 (56.5%)
19 (22.4%)
5 (5.9%)
37.2 ± 7
63.6 ± 11.8
15 (17.6%)
23 (27.1%)
111.6 ± 11.7
65 (76.5%)
81 (95.3%)
82 (97.6%)
79 (92.9%)
76 (89.4%)
55 (64.7%)
60.6 ± 9.4 **
139 (78.1%)
25.5 ± 3.0
122 (68.5%)*
66 (37.1%)
7 (3.9%)
88 (49.4%)
25 (14.0%)
10 (5.6%)
36.7 ± 5
63.3 ± 11.8
10 (5.6%)**
25 (14.0%)*
101.2 ± 10.8**
50 (28.1%)**
167 (93.8%)
173 (97.2%)
162 (91.0%)
154 (86.5%)
127 (71.3%)
2.72 ± 0.6
3.9 ±0.7
2.84 ± 0.7
4.0 ±0.7
11 (12.9%)
13 (15.3%)
1 (1.2%)
64.1 ± 82.2
7.8 ± 6.0
6 (3.4%)**
13 (7.3%)*
5 (2.8%)
36.2 ± 49.5**
4.8 ± 2.8**
 Multivariate analysis showed that only older age (odds ratio 1.06
per year increment, 95% confidence intervals [CI] 1.02 to 1.10, P <
0.01) and POPWD > 105 ms (odds ratio 9.23, 95% CI 4.83 to 17.84,
P < 0.001) were independently associated with the occurrence of
POAF.
In-hospital outcomes
Infection, n (%)
Renal dysfunction, n (%)
Myocardial infarction, n (%)
Mechanical ventilation time (hrs)
ICU stay (days)
 Patients with AF could be predicted by POPWD of longer than 105
ms, with specificity, positive and negative predicted values of 72%,
76%, and 72%, respectively.
*P < 0.05, ** P < 0.01. Data are presented n (%) or mean±SD.
BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease, LVEF = Left ventricular ejection
fraction, RCA = Right coronary artery, ACEI = Angiotensin-converting enzyme inhibitor, ARB = Angiotensin
receptor blocker.
 Old age, prolonged POPWD, hypertension, aortic and mitral
regurgitation were associated with POAF (Table 1).
Figure 1. Temporal distribution of POAF. Note that most of the postCABG AF occurred between day 1 and day 4.
Figure 2. Comparison of POPWD between AF and SR groups in the 11
included studies
CONCLUSIONS
This study confirmed that POPWD was a powerful independent
predictor of POAF among other predictive characteristics.
The present study was funded by National Natural Science
Foundation of China. There are no unlabled/
unapproved uses of drugs or products.