Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis.
Fangqin Wu, Ying Wu, Wenyan Tao and 2 others
PMID 31406817WHAT IT FOUND
A longer preoperative P-wave on ECG was linked to more AF after bypass surgery.
A P-wave of 105 ms or more caught 74% of AF cases and was normal in 65% of patients without AF.
Key findings
01Of 299 analyzed patients, 33.1% developed AF after CABG, and 83.5% of first episodes occurred between postoperative days 1 and 3.
02A preoperative P-wave duration of 105 ms or more was associated with POAF after adjustment for age and hypertension, and it caught 74% of AF cases and was normal in 65% of patients without AF.
03In the meta-analysis of 3141 patients, patients with AF had a weighted mean PreOPWD 3.95 ms longer than patients without AF, but heterogeneity was high.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational, so it shows an association between P-wave duration and AF, not that P-wave duration caused AF or that acting on it improves outcomes. No prophylactic treatment or monitoring strategy was tested, so it cannot show that using the 105 ms cutoff reduces AF or complications. The cohort came from two centers in Beijing and included only first isolated off-pump CABG patients in sinus rhythm, excluding prior AF, atrial tachycardia, and concomitant valvular surgery. Monitoring was limited to the first week after surgery, and the authors note this could miss AF occurring later, though prior studies say AF was rarely observed after day 7. The 105 ms cutoff had sensitivity 74% and specificity 65%, so it would miss some AF and flag some patients who do not develop AF. The meta-analysis had significant heterogeneity (P < 0.0001, I2 = 74%), and P-wave measurement methods varied across included studies.
Declared interests
The authors declared no actual or potential conflicts of interest, including financial, personal, or other relationships. Funding was not reported.
The easy way to misread this
Do not conclude that screening for a P-wave of 105 ms or more and giving prophylaxis prevents AF or improves outcomes. This was an observational prediction study, and it did not test any preventive treatment.