This comprehensive study investigated the
relationship between CABG surgery and POAF.
The most important finding in this study was that
PWPT-V1, an ECG parameter, was an independent
predictor of POAF.
In the past, AF was not considered a significant
complication after heart surgery. However, a study has
revealed that POAF affects mortality and morbidity.[10]
In a study conducted with CABG patients, patients
with POAF were examined. A prolonged need for ventilation and longer stays in the intensive care unit
and hospital were observed in patients with POAF.[11]
It has also been revealed that POAF is associated with
an increased risk of mortality and stroke in the long
term.[12]
Since it is understood that POAF developing after
cardiac surgery can lead to significant complications,
it becomes important to identify patients at high risk
for AF. For this purpose, conduct comprehensive
studies on POAF have been conducted.
Some factors may lead to the development
of POAF. A study found a relationship between
hypoxemia and POAF.[13] In another study, a
relationship was found between different surgical
techniques and POAF.[14] The multitude of risk factors
that can lead to AF can lead to the development of
POAF. In a meta-analysis with 36,834 participants,
advanced age, increased left atrium diameter, low
ejection fraction, chronic obstructive pulmonary
disease, hypertension, myocardial infarction, and
diabetes were found to be associated with the
development of POAF.[15]
In the ECG, the wave associated with atrial
depolarization is the P wave. Structural changes and
arrhythmias in the atria can cause changes in the
P wave. Therefore, studies have examined whether
there is a relationship between P-wave changes and
POAF. An ECG taken before undergoing surgery is
the simplest method that can be used to predict POAF.
In recent studies, the relationship between
PWPT, a new ECG parameter, and AF has been
examined. In a study conducted with patients in sinus
rhythm with acute ischemic stroke, a significant
relationship was found between paroxysmal AF
detected in Holter ECG and P-wave duration,
dispersion, and terminal force in ECGs.[26] In
another study on acute ischemic stroke patients,
it was examined whether there was a relationship
between PWPT and paroxysmal AF, and it was
determined that there was a relationship between
PWPT and AF.[16] Another study found PWPT-D2
and PWPT-V1 to be strong markers predicting
POAF in patients.[17] Unlike our study, it was
found that only PWPT-V1 could be associated
with POAF. Furthermore, the AUC, sensitivity,
and specificity values of PWPT-V1 in our study in
the ROC curve analysis were higher compared to
the previous study.[17] We did not have information
about the coronary lesions of the CABG patients included in the study. In a study, PWPT-V1 was
found to be significantly longer in the multivessel
slow flow group than in the single-vessel group.[18]
It was stated that these findings may be related to
ischemia being affected by a larger myocardial area
and multivessel slow flow.[18] The significant results
observed in PWPT-V1 in our study may be due to
these reasons.
In IAB, the activation time between the atria is
longer than normal. Therefore, the P-wave duration of
patients with IAB is ≥120 msec.[19] It was demonstrated
that IAB may lead to AF.[20] In one study, IAB was
found to be a predictor of AF in patients with
coronary artery disease and carotid artery disease.[21]
Interatrial block is important because it is commonly
found in the elderly population and has previously
been associated with AF.[22] In a study, it was found
that IAB detected the emergence and recurrence
of AF.[23] Bachmann's area is the largest interatrial
conduction pathway. It is thought that fibrosis in this
region may lead to IAB.[21] The fact that IAB was
statistically significant in our study can be explained
by this mechanism.
Age is an independent risk factor for the
development of AF.[24] It is estimated that AF
observed in elderly patients in the European
Union will be more than twice as common after
50 years.[25] With this study, we determined the
relationship between age and AF and found that
one of the most important risk factors for POAF is
advanced age.
Atrial fibrillation is a high-risk disease group in
terms of ischemic events. Therefore, cerebrovascular
events may occur more frequently in these patients. This
may explain the higher incidence of cerebrovascular
events in the AF group in our study.
The most important limitation of the study
was the retrospective design. Lack of sufficient
knowledge about the surgical techniques applied
was also a significant limitation since the surgical
techniques applied may have affected PWPT-V1
values. The data on the anesthetic drugs given
to patients before surgery were also absent. The
anesthetic agents given may also have influenced
PWPT-V1 values. Multicenter, prospective,
randomized controlled studies are needed to better
understand whether this parameter is predictive of
POAF.
In conclusion, PWPT-V1 can predict the
development of POAF in patients undergoing CABG.
Utilizing this parameter, necessary prophylactic
treatments can be performed in these patients before
surgery, reducing mortality and morbidity.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept, design, control/
supervision, analysis and/or interpretation, literature review,
writing the article, critical review, materials: İ.K., E.K.; Data
collection and/or processing: İ.K.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
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