Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Abstract

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir ABSTRACTObjective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kard...

Depolarization and repolarization parameters on ECG predict recurrence after atrial fibrillation ablation in patients with hypertrophic cardiomyopathy

“…A prospective observation study found that patients with fQRS had more paroxysmal atrial fibrillation (PAF) episodes (22.3% vs 4.1%) and fQRS was an independent predictor of PAF episodes on routine Holter monitoring . It was recently reported that fQRS could predict new‐onset AF in patients with ischemic heart disease, either after an attack of ST‐elevation myocardial infarction or after coronary artery bypass surgery . Our study improves our understanding of preprocedural fQRS as an independent risk factor of arrhythmia recurrence in HCM patients undergoing AF ablation.…”

“…As an inherited cardiomyopathy, however, myocardial disorders in HCM are not necessarily limited to the ventricles but can develop in the atria as well. A previous study has shown that the presence of fQRS is an independent predictor of postoperative AF in patients undergoing isolated coronary artery bypass graft surgery . Similarly, prolongation of the QTc interval, another ECG parameter predominantly representing myocardial repolarization time, has been linked to ventricular myocardial scarring or fibrosis .…”

Assessment of the relationship between fragmented QRS and cardiac iron overload in patients with beta-thalassemia major

“…The study which includes patients presenting with ST-segment elevation myocardial infarction, the presence of fQRS in application of ECG, may help to identify high-risk cardiac patients have been reported (34). In another study which includes patients with coronary artery disease, the presence of fQRS on ECG in patients with prior CABG, has been shown to have a higher risk of developing AF in the postoperative period (35). Also in researches in patients with arryhtmogenic right ventricular dysplasia (ARVD) and hypertrophic cardiomyopathy, presence of fQRS on the surface ECG, is reported to be a predictor for arrhythmic events (36, 37).…”

Value of Fragmented QRS for Predicting Paroxysmal Atrial Fibrillation Episodes

“…Indeed it was demonstrated that the fQRS was as predictor of the occurrence of post-operative atrial fibrillation (AF) in isolated coronary artery by-pass surgery. 9 …”