Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2022 Sep 15;363:71-79. doi: 10.1016/j.ijcard.2022.06.015. Epub 2022 Jun 12.
PoAF is the most common complication after cardiac surgery and may occur in patients with pre-existing arrhythmogenic substrate. Characterization of this substrate could aid in identifying patients at risk for PoAF. We therefore compared intra-atrial conduction parameters and electrogram morphology between patients without and with early- (≤5 days after surgery) and late- (up to 5 years) postoperative atrial fibrillation (PoAF).
Epicardial mapping of the right and left atrium and Bachmann's Bundle (BB) was performed during sinus rhythm (SR) in 263 patients (207male, 67 ± 11 years). Unipolar potentials were classified as single, short or long double and fractionated potentials. Unipolar voltage, fractionation delay (time difference between the first and last deflection), conduction velocity (CV) and conduction block (CB) prevalence were measured. Comparing patients without (N = 166) and with PoAF (N = 97), PoAF was associated with lower CV and more CB at BB. Unipolar voltages were lower and more low-voltage areas were found at the left and right atrium and BB in PoAF patients. These differences were more pronounced in patients with late-PoAF (6%), which could even occur up to 5 years after surgery. Although several electrophysiological parameters were related to PoAF, age was the only independent predictor.
Patients with de novo PoAF have more extensive arrhythmogenic substrate prior to cardiac surgery compared to those who remained in SR, which is even more pronounced in late-PoAF patients. Future studies should evaluate whether intra-operative electrophysiological examination enables identification of patients at risk for developing PoAF and hence (preventive) therapy.
房性心动过速（PoAF）是心脏手术后最常见的并发症，可发生在存在潜在致心律失常基质的患者中。对这种基质的特征进行描述可以帮助识别发生 PoAF 的风险患者。因此，我们比较了窦性心律（SR）期间无早期（术后≤5 天）和晚期（术后长达 5 年）房性心动过速（PoAF）患者的房间内传导参数和电图形态。
在 263 例患者（207 例男性，67±11 岁）中进行了右心房和左心房以及 Bachmann 束（BB）的心外膜标测。将单极电位分为单极、短或长双极和分极电位。测量单极电压、分极延迟（第一个和最后一个偏折之间的时间差）、传导速度（CV）和传导阻滞（CB）的发生率。比较无 PoAF（N=166）和 PoAF（N=97）患者，PoAF 与 BB 处 CV 降低和 CB 发生率增加相关。PoAF 患者左、右心房和 BB 处的单极电压较低，低电压区较多。这些差异在晚期 PoAF（6%）患者中更为明显，甚至可能在手术后 5 年内发生。尽管几个电生理参数与 PoAF 相关，但年龄是唯一的独立预测因素。
与仍处于 SR 的患者相比，新发 PoAF 患者在心脏手术前存在更广泛的致心律失常基质，晚期 PoAF 患者更为明显。未来的研究应评估术中电生理检查是否能够识别发生 PoAF 的风险患者，从而进行（预防性）治疗。
