Meta-analysis of P wave character as predictor of atrial fibrillation after coronary artery bypass grafting

Predicting atrial fibrillation after cardiac surgery: a scoping review of associated factors and systematic review of existing prediction models

INTRODUCTION

Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models.

METHODS

We screened articles from Ovid MEDLINE® and PubMed Central® (PMC) and included studies that evaluated risk factors associated with POAF or studies that designed or validated POAF prediction models. We only included studies in cardiac surgical patients with sample size n ⩾ 50 and a POAF outcome group ⩾20. We summarised factors that were associated with POAF and assessed prediction model performance by reviewing reported calibration and discriminative ability.

RESULTS

We reviewed 232 studies. Of these, 142 fulfilled the inclusion criteria. Age was frequently found to be associated with POAF, while most other variables showed contradictory findings, or were assessed in few studies. Overall, 15 studies specifically developed and/or validated 12 prediction models. Of these, all showed poor discrimination or absent calibration in predicting POAF in externally validated cohorts.

CONCLUSIONS

Except for age, reporting of factors associated with POAF is inconsistent and often contradictory. Prediction models have low discrimination, missing calibration statistics, are at risk of bias and show limited clinical applicability. This suggests the need for studies that prospectively collect AF relevant data in large cohorts and then proceed to validate findings in external data sets.

The amplitude of fibrillatory waves on leads aVF and V1 predicting the recurrence of persistent atrial fibrillation patients who underwent catheter ablation

OBJECTIVE

To evaluate whether the amplitude of fibrillatory wave (F wave) on electrocardiography could predict the recurrence in persistent atrial fibrillation (AF) patients who underwent catheter ablation.

METHODS

All consecutive persistent AF patients who underwent catheter ablation at Peking Union Medical College Hospital between November 2006 and February 2012, were enrolled. The amplitude of F wave was measured on three orthogonal leads (leads I, V1 and aVF) on the Prucka CardioLab recording system. The primary end point was the recurrence after catheter ablation.

RESULTS

A total of 54 persistent AF patients were enrolled. Fifty patients (age: 58 ± 11years, 72% male) constituted the study population after excluding four patients lost of follow-up. The duration of AF was 9 ± 7 (2-18) months. Twenty-four patients (48%) recurred during the follow-up of 25 ± 19 months, constituted recurrence group. The remaining 26 patients constituted control group. The F-wave amplitude in recurrence group was significantly lower than control group (lead aVF, 0.085 ± 0.018 vs. 0.111 ± 0.036mV, P = 0.002; lead V1 , 0.116 ± 0.031 vs. 0.148 ± 0.047mV, P = 0.008). The amplitudes of leads aVF (P = 0.023) and V1 (P = 0.031) were the independent predictors of AF recurrence. The sensitivity and specificity of F-wave amplitude of lead aVF < 0.093mV or V1 < 0.123mV to predict the recurrence were 75% and 73%, 68% and 64%, respectively.

CONCLUSION

The low amplitudes of F wave in leads aVF and V1 could predict the recurrence of patients with persistent AF who underwent catheter ablation.