Çetin Mustafa, Kocaman Sinan Altan, Erdoğan Turan, Durakoğlugil Murtaza Emre, Çiçek Yüksel, Bozok Şahin, Çanga Aytun, Temiz Ahmet, Doğan Sıtkı, Şatıroğlu Ömer
Clinic of Cardiology, Rize Education and Research Hospital, Rize-Turkey.
Anadolu Kardiyol Derg. 2012 Nov;12(7):576-83. doi: 10.5152/akd.2012.184. Epub 2012 Jul 17.
Fragmented QRS complexes (fQRS) are defined as various RSR' patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study.
The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC).
POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810).
In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF.
碎裂QRS波群（fQRS）被定义为两个相邻导联中对应主要冠状动脉区域的各种RSR′模式。尽管fQRS与心脏事件之间关联的原因被认为是心脏纤维化，但fQRS对术后房颤（POAF）的预测作用尚未在接受单纯冠状动脉旁路移植术（CABG）的患者中进行研究，POAF是该手术中常见且严重的并发症。因此，本研究对这一问题进行了调查。
本研究采用前瞻性观察设计。连续纳入272例接受单纯CABG手术的符合条件患者。将患者分为术后房颤（AF）组和非AF组。研究CABG术后新发AF的发生情况及其与fQRS的关系。采用逻辑回归分析确定POAF的独立预测因素。使用受试者操作特征曲线（ROC）计算研究变量预测POAF的敏感性和特异性。
272例患者中有62例（22.8%）发生POAF。与非AF患者相比，POAF患者通常年龄更大（p<0.001）、为女性（p=0.006）、有高血压病史（p=0.008）、血红蛋白水平较低（p=0.011）、患有慢性阻塞性肺疾病（p=0.003）、QRS时间延长（p=0.004）且欧洲心脏手术风险评估系统（EUROSCORE）评分较高（p<0.001）。POAF患者的左心室射血分数较低（p<0.001）且fQRS发生率较高（p<0.001），但左心房大小（LA）相似（p=无显著性差异）。有趣的是，fQRS患者的LA大小显著增大（3.8±0.6 vs. 4.1±0.5 cm，p=0.002）。此外，POAF患者在心脏外科重症监护病房的停留时间延长（p<0.001）且住院时间延长（p=0.001）。新发POAF与fQRS的存在及数量显著相关。在逻辑回归分析中，只有年龄（比值比：1.044，95%可信区间：1.008 - 1.082，p=0.016）、女性性别（比值比：2.347，95%可信区间：1.079 - 5.106，p=
