Atrial fibrillation after non-cardiac surgery: P-wave characteristics and Holter monitoring in risk assessment.
BACKGROUND
We investigated the role of 12-lead ECG P-wave duration and dispersion and of Holter monitoring as predictors of post-thoracic surgery atrial fibrillation.


METHODS
One hundred and five consecutive patients (88 males-17 females; age 60+/-9), undergoing thoracic surgery at National Cancer Institute between 2001 and 2003, were enrolled and both standard ECG and Holter monitoring were obtained from each patient. P-wave study was made on a magnified ECG paper copy. Holter monitoring was performed 1-3 days before surgery; patients were divided into three classes according to number and complexity of premature supra ventricular complexes (0: <30/h and no repetitive forms; 1: >30/h or couplets; 2: run of supraventricular tachycardia or atrial fibrillation).


RESULTS
Atrial fibrillation was detected in 12 patients (11%) within 96 h from surgery. In univariable logistic model, P-wave duration was not associated with postoperative atrial fibrillation while P-wave dispersion and Holter monitoring demonstrated a statistically significant association with the occurrence of atrial fibrillation (OR of 30 vs 20 ms=2.06; CI: 1.17-3.64; p=0.012, OR of class 1-2 vs class 0=8.16; CI: 2.04-35.59; p=0.003, respectively). In the multivariable model, both P-wave dispersion and Holter were shown to be significantly associated with the end-point. Holter monitoring enhanced the predictive ability of P-wave dispersion (area under the ROC curve increased from 0.64 to 0.80).


CONCLUSIONS
P-wave dispersion, but not duration, was associated with atrial fibrillation after thoracic surgery. Preoperative Holter monitoring adds further information and could be used to enhance the P-wave predictive power.
Materazzo
Carlo
C
Cardiology Unit, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. carlo.materazzo@istitutotumori.mi.it
Piotti
Patrizia
P
Mantovani
Costanza
C
Miceli
Rosalba
R
Villani
Fabrizio
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods; D009369:Neoplasms / Q000503:physiopathology / Q000601:surgery; D011184:Postoperative Period; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D013997:Time Factors