Klein M, Evans S J, Blumberg S, Cataldo L, Bodenheimer M M
Division of Cardiology, Harris Chasanoff Heart Institute, New Hyde Park, NY 11042, USA.
Am Heart J. 1995 May;129(5):895-901. doi: 10.1016/0002-8703(95)90109-4.
Atrial fibrillation occurs commonly after coronary artery bypass surgery. However, despite numerous attempts at prediction, no accurate and generally accepted method exists to predict its occurrence. P-wave-triggered P-wave signal averaging was performed on 54 patients before coronary artery bypass surgery to evaluate the utility of this method to predict atrial fibrillation after coronary artery bypass surgery. After excluding six patients with unevaluable P-wave signal averages and three patients with postoperative arrhythmias other than atrial fibrillation, the P-wave signal averages of 45 patients were analyzed. Sixteen patients had postoperative atrial fibrillation and 29 did not. The mean P-wave duration of the filtered, signal-averaged P wave was 163 +/- 19 msec in the 16 patients with atrial fibrillation and 144 +/- 16 msec in the 29 patients without (p < 0.005). Left atrial enlargement on the surface electrocardiogram (ECG) was the only other statistically significant variable that correlated weakly with the onset of postoperative atrial fibrillation (p = 0.04). Other clinical variables such as P-wave duration in ECG lead II, left ventricular hypertrophy on ECG, age, sex, hypertension, and left ventricular ejection fraction were not significantly different between the two groups. With a cut point of 155 msec, chi-squared analysis revealed a p value of < 0.005, yielding a sensitivity of 69%, a specificity of 79%, a positive predictive value of 65%, and a negative predictive value of 82%. Signal-averaging of the P wave in patients before coronary artery bypass surgery provides a good predictor of postoperative atrial fibrillation.
冠状动脉搭桥手术后常发生心房颤动。然而，尽管进行了多次预测尝试，但尚无准确且被普遍接受的方法来预测其发生。对54例冠状动脉搭桥手术前的患者进行了P波触发的P波信号平均分析，以评估该方法预测冠状动脉搭桥手术后心房颤动的效用。排除6例P波信号平均无法评估的患者和3例术后除心房颤动外还发生其他心律失常的患者后，对45例患者的P波信号平均进行了分析。16例患者术后发生心房颤动，29例未发生。发生心房颤动的16例患者中，经滤波、信号平均后的P波平均持续时间为163±19毫秒，未发生心房颤动的29例患者中为144±16毫秒（p<0.005）。体表心电图（ECG）显示的左心房扩大是唯一与术后心房颤动发作有弱相关性的其他具有统计学意义的变量（p = 0.04）。两组之间的其他临床变量，如ECG导联II中的P波持续时间、ECG显示的左心室肥厚、年龄、性别、高血压和左心室射血分数，无显著差异。以155毫秒为切点，卡方分析显示p值<0.005，敏感性为69%，特异性为79%，阳性预测值为65%，阴性预测值为82%。冠状动脉搭桥手术前患者的P波信号平均可为术后心房颤动提供良好的预测指标。
