P-wave indices: manifest atrial fibrillation after postoperative atrial fibrillation?

Abstract Objectives: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up. Methods: We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score matched cohorts (POAF vs sinus rhythm), ECGs were evaluated regarding P-wave duration, amplitude, morphology, variability and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding development of manifest AF after POAF was analyzed. Results: From 212 patients included, 50 patients (23.6 %) developed POAF. Ninety patients underwent PSM, 64 (71 %) participated in follow-up, 21 (23 %) died prior to follow up (POAF: 13 vs. SR: 8), and 5 (6 %) withdrew consent. No patient developed persistent AF. In 9 patients paroxysmal AF events were detected (POAF: 6 vs. SR: 3). P-wave duration, P-dispersion, P-amplitude and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, P-dispersion and PWPT increased and P-amplitude decreased in these. Preoperative beta-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients. Conclusion: Patients with POAF are prone to episodes of paroxysmal AF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.

Publication History

Received: 19 July 2024

Accepted after revision: 17 May 2025

Accepted Manuscript online:
20 May 2025