Preoperative P-wave parameters and risk of atrial fibrillation after cardiac surgery: a meta-analysis of 20 201 patients

Abstract

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.

Influence of epicardial adipose tissue inflammation and adipocyte size on postoperative atrial fibrillation in patients after cardiovascular surgery

“…Postoperative AF (POAF) may prolong hospital stay after open‐heart surgery, with an increased risk of stroke (Greenberg et al., 2017 ). Advanced age (Seo et al., 2021 ), atrial structural and electrical remodeling (Kawczynski et al., 2021 , 2022 ; Lotter et al., 2023 ), obesity, and metabolic syndrome have been associated with increased POAF frequency (Maesen et al., 2012 ); however, the precise mechanism underlying its occurrence remains unclear.…”

The Effect of Obesity on Repolarization and Other ECG Parameters

“…Similarly, weight loss due to diet and medical therapy or diet only resulted in decreased P-wave duration and dispersion [ 34 , 35 ]. Prolonging P-wave width or dispersion is associated with a higher risk of developing supraventricular arrhythmias, including atrial fibrillation [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ].…”