Prediction of atrial fibrillation after coronary artery bypass grafting: The role of chemoreflexsensitivity and P wave signal averaged ECG

Electrophysiological Changes Preceding the Onset of Atrial Fibrillation After Coronary Bypass Grafting Surgery

“…The difference between vagal and sympathetic stimulations might lie in the more spatially heterogeneous effect of vagal nerve activation. It has been put forward that elevated norepinephrine levels suggest sympathetic activation, while some other studies rather suggested divergent autonomic conditions to occur before arrhythmia onset, either heightened sympathetic or parasympathetic tone, or even dysfunctional autonomic heart rate control [13,48,64,86,89]. In both raw data and position data, we found an increasing trend of mean LFPortion in the last 30 minutes, reaching a peak in the last 10 minutes before AF.…”

“…Heterogeneous electrophysiological properties could be due to autonomic innervations [88], while their possible implication in postoperative AF is complex, sometimes even controversial [13,48,64,86,89]. It was reported that either vagal or sympathetic nerve stimulation, can decrease the atrial refractory period in a spatially heterogeneous way, thereby facilitating the occurrence of AF [90][91][92][93][94].…”

Signal-Averaged ECG: Basics to Current Issues

“…Prolonged iltered P-wave duration (FPD) in P-wave signal-averaged electrocardiography has been used as a noninvasive, powerful predictor of AF, the irst episode and recurrences, in lone, occult or silent atrial ibrillation, in stroke, heart failure, hypertension, hypertrophic cardiomyopathy, hypothyroidism and in patients undergoing coronary artery bypass surgery [44][45][46]. A prolonged SAECG P-wave duration was also mentioned in septal atrial defect, especially in patients who experienced AF, not corrected after atrial septal defect closure, and it was demonstrated that atrial conduction disturbances occur early, requiring an early intervention to prevent the development of late AF ( Table 2) [47].…”

“…There is no consensus about the cut-of point for FPD, which was 121 ms in hypertensive patients Auriti et al [48], 124 ms in patients in sinus rhythm, 136 ms in hypertensive patients with a history of atrial ibrillation, 132 ms in patients with COPD, and 155 ms in several other studies [43,45,46,49], diferences related to diferent averaging and iltering methods [45].…”

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

“…Of the remaining 25 papers examined in more detail, 11 either were missing control groups or were review articles, and 2 were not target endpoint studies. Thus, twelve studies with 12 articles (11 English articles, 1 Chinese article), including a total of 3134 patients, were eligible for review [2][3][4][5][6][7][8][9][10][11][12][13].…”