Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?

Christian Peter Erich Rau; Miriam Salzmann-Djufri; Andreas Böning; Susanne Rohrbach; Bernd Niemann

doi:10.1055/a-2616-3919

May 20, 2025The Thoracic and Cardiovascular Surgeon

Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?

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Why the study?

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, but its effect on the manifestation of atrial fibrillation during long-term follow-up required investigation.

Does postoperative atrial fibrillation and associated P-wave indices predict the development of manifest atrial fibrillation in patients undergoing cardiac surgery?

Structured PICO

Does postoperative atrial fibrillation and associated P-wave indices predict the development of manifest atrial fibrillation in patients undergoing cardiac surgery?

P

Population

212 patients undergoing cardiac surgery, of which 50 (23.6%) developed postoperative atrial fibrillation (POAF). 90 patients underwent propensity score matching.

I

Intervention

Postoperative atrial fibrillation (POAF)

C

Comparator

Propensity score-matched sinus rhythm (SR)

O

Outcome

Development of manifest atrial fibrillation (AF) during long-term follow-uphard clinical

Implication

P-wave indices and their perioperative dynamics may help identify patients at higher risk of developing manifest atrial fibrillation after experiencing postoperative atrial fibrillation.

Abstract

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score-matched cohorts (POAF vs. sinus rhythm [SR]), ECGs were evaluated regarding P-wave duration (PWD), amplitude (PWA), morphology, variability, and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding the development of manifest AF after POAF was analyzed.Of 212 patients included, 50 patients (23.6%) developed POAF. Ninety patients underwent propensity score matching (PSM), 64 (71%) participated in follow-up, 21 (23%) died prior to follow-up (POAF: 13 vs. SR: 8), and 5 (6%) withdrew consent. No patient developed persistent AF. In nine patients, paroxysmal AF (pAF) events were detected (POAF: 6 vs. SR: 3). PWD, P-dispersion (PD), PWA, and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, PD and P-wave peak time (PWPT) increased, and P-amplitude decreased in these. Preoperative β-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients.Patients with POAF are prone to episodes of pAF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.