Key result
Temporal dispersion of atrial activation rises ~9-fold just before postoperative AF onset.
Why the study?
Spatial dispersion of atrial activation causes postoperative atrial fibrillation after cardiac surgery, but whether temporal dispersion of atrial activation causes PoAF in a clinical setting remained to be evaluated.
Observational (n=19)
No
Temporal dispersion of atrial activation significantly increases just prior to the onset of postoperative atrial fibrillation, suggesting it is a precursory marker.
BACKGROUND: Spatial dispersion of atrial activation is a cause of postoperative atrial fibrillation (PoAF) after cardiac surgery. This study evaluated whether temporal dispersion of atrial activation causes PoAF after surgery in a clinical setting. METHODS: Nineteen patients were enrolled. Postoperative atrial activation was evaluated by 24-hour Holter electrocardiography, with atrial pacing wires on the right atrium, for 5 days after cardiac surgery. No patient received antiarrhythmic drugs, including beta-blockers. The cycle length of 15 continuous atrial beats was measured at 4 time points: (i) earlier than 12 hours before PoAF, as a control, (ii) just before PoAF onset, (iii) during PoAF, and (iv) just before cessation of PoAF. Inhomogeneity of atrial activation was quantified by using the variation coefficient for a cycle length of 15 atrial beats during each phase. RESULTS: The median inhomogeneity index of atrial activation (interquartile range) was 0.102 (0.046-0.136) in controls, 0.943 (0.582-1.610) just before PoAF onset (vs. control; p=0.009), 0.966 (0.631-1.117) during PoAF, and 0.471 (0.138-0.645) just before cessation of PoAF. CONCLUSIONS: Dispersion of atrial activation significantly increased just before PoAF onset. Temporal dispersion of atrial activation is a precursory variation of PoAF.
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Kawase et al. (2019) conducted an observational in Postoperative atrial fibrillation (n=19). 24-hour Holter electrocardiography with atrial pacing wires vs. Control period (>12 hours before PoAF) was evaluated on Inhomogeneity index of atrial activation (p=0.009). Temporal dispersion of atrial activation significantly increased just before the onset of postoperative atrial fibrillation, with the median inhomogeneity index rising from 0.102 to 0.943.
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