HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Materazzo, C. Articles by Villani, F. Search for Related Content PubMed PubMed Citation Articles by Materazzo, C. Articles by Villani, F. Related Collections Lung - cancer Lung - other Cardiac - other Electrophysiology - arrhythmias

Eur J Cardiothorac Surg 2007;31:812-816. doi:10.1016/j.ejcts.2007.02.007
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Atrial fibrillation after non-cardiac surgery: P-wave characteristics and Holter monitoring in risk assessment

^a Cardiology Unit, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy
^b Unit of Medical Statistics and Biometry, National Cancer Institute, Milan, Italy
^c Pneumology Unit, National Cancer Institute, Milan, Italy

Received 8 November 2006; received in revised form 6 February 2007; accepted 6 February 2007.

^_* Corresponding author. Tel.: +39 02 2390 2307; fax: +39 02 2390 2513. (Email: carlo.materazzo{at}istitutotumori.mi.it).

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.

Key Words: Post-surgery atrial fibrillation • P-wave duration and dispersion • ECG Holter monitoring