Aims This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen’s d = 1.4, 95% confidence interval (CI) 0.9–1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen’s d = 0.8, 95% CI 0.6–1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen’s d = 1.4, 95% CI 1.0–1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.
Objectives To evaluate the role of P-wave parameters, as defined on preprocedural electrocardiography (ECG), in predicting atrial fibrillation (AF) after cardiac surgery (POAF). Methods Pubmed, Cochrane library, and Embase were searched for studies reporting on P-wave parameters and risk of POAF. Meta-analysis of P-wave parameters reported by at least five different publications was performed. In case of receiver operator characteristics (ROC-curve) analysis in the original publications, a ROC meta-analysis was performed to summarize the sensitivity and specificity. Results Thirty-two publications, with a total of 20,201 patients, contributed to the meta-analysis. Increased P-wave duration, measured on conventional 12-lead ECG (22 studies, Cohen’s d = 0.4, 95% confidence interval: 0.3–0.5, p < 0.0001) and signal-averaged ECG (SAECG) (12 studies, Cohen’s d = 0.8, 95% confidence interval: 0.5–1.2, p < 0.0001), was a predictor of POAF independently from left atrial size. ROC meta-analysis for SAECG P-wave duration showed an overall sensitivity of 72% (95% confidence interval: 65–78%) and specificity of 68% (95% confidence interval: 58–77%). Summary ROC-curve had a moderate discriminative power with an area under the curve of 0.76. There was substantial heterogeneity in the meta-analyses for P-wave dispersion and PR-interval. Conclusion This meta-analysis shows that increased P-wave duration, measured on conventional 12-lead ECG and SAECG, predicted POAF in patients undergoing cardiac surgery.
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