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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

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