Fragmented QRS complexes are associated with postoperative atrial fibrillation development after coronary artery bypass grafting surgery

Hasan Attila Keskin; Alparslan Kurtul

doi:10.1097/mca.0000000000000897

April 16, 2020Coronary Artery Disease

Fragmented QRS complexes are associated with postoperative atrial fibrillation development after coronary artery bypass grafting surgery

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Why the study?

Postoperative atrial fibrillation is a frequent, morbid complication after CABG, and the prognostic value of admission ECG fragmented QRS complexes for its development needed evaluation.

Does the presence of fragmented QRS on admission ECG predict the development of postoperative atrial fibrillation in patients undergoing CABG surgery?

Structured PICO

Does the presence of fragmented QRS on admission ECG predict the development of postoperative atrial fibrillation in patients undergoing CABG surgery?

P

Population

242 patients undergoing isolated coronary artery bypass grafting (CABG) surgery between February 2016 and June 2018

I

Intervention

Presence of fragmented QRS (fQRS) on admission 12-lead surface ECG

C

Comparator

Absence of fragmented QRS (fQRS) on admission 12-lead surface ECG

O

Outcome

Development of postoperative atrial fibrillation (PoAF)hard clinical

Implication

The presence of fragmented QRS on a preoperative ECG serves as a simple, noninvasive predictor for the development of postoperative atrial fibrillation in patients undergoing CABG.

Abstract

OBJECTIVE: Postoperative atrial fibrillation (PoAF) is one of the most frequent complications and a major risk factor of morbidity and mortality after coronary artery bypass grafting (CABG). Fragmented QRS complex (fQRS) on a 12-lead surface ECG is recently gained increasing attention as a simplified noninvasive ECG marker with diagnostic and prognostic value in various cardiac conditions. The aim of the present study was to evaluate the association between development of PoAF and presence of fQRS on admission ECG in patients undergoing CABG surgery. METHODS: A total of 242 patients who underwent CABG between February 2016 and June 2018 were included in this study. The patients were divided into two groups as developing and nondeveloping PoAF groups in the postoperative period. fQRS was defined as the presence of various RSR' patterns including an additional R wave, notching of the R or S waves, or the presence of more than one fragmentation in two contiguous leads. RESULTS: In-hospital mortality was higher in PoAF (+) group compared to PoAF (-) group (20.5 vs. 6.4%, P = 0.004). PoAF rate was higher in fQRS (+) group than fQRS (-) group (25.3 vs. 9.8%, P = 0.001). In multivariate analysis, the presence of fQRS complexes on admission ECG [odds ratio (OR) 2.801, 95% confidence interval (CI) 1.262-6.211, P = 0.011) and hemoglobin (OR 0.794; 95% CI, 0.641-0.985; P = 0.036) were identified as independent predictors of PoAF after CABG surgery. CONCLUSION: The presence of fQRS on admission ECG was found to be an independent predictor of PoAF in patients undergoing isolated CABG.