Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis

Objectives: Reported prediction rules for postoperative atrial fibrillation (AF) have suffered from inconsistent results and controversy surrounding the predictive value of a preoperative P-wave duration (PreOPWD). This study examined PreOPWD as a predictor for AF after coronary artery bypass grafting (CABG). Methods: Two-hundred-and-ninety-nine patients with sinus rhythm before off-pump CABG were recruited into the study. Patients' demographic and clinical data were evaluated prospectively. Patients were continuously monitored for the first seven postoperative days. Multiple logistic regression was used to determine significant predictors of AF. Findings were then combined with similar studies and a meta-analysis was performed. Results: Postoperative AF was observed in 33.1% of 299 patients. Patients with AF were older, had a prolonged PreOPWD, higher incidences of hypertension, aortic regurgitation, and mitral regurgitation. A cut-off point of PreOPWD≥105 ms achieved a specificity of 74%, and a sensitivity of 65% for predictive of AF. Multivariate analysis showed that PreOPWD≥105 ms (odds ratio [OR] 4.63, 95% confidence intervals [CI] 2.66 to 8.03, P < 0.001), age≥60 years (OR 2.72, 95% CI 1.51 to 4.90, P < 0.01) and hypertension (OR 2.10, 95% CI 1.08 to 4.07, P < 0.05) independently predicted postoperative AF. A meta-analysis of this data combined with those of ten other studies showed that PreOPWD was greater in patients with POAF, with a weighted mean difference of 3.95 ms (95% CI 1.97 to 5.92, P < 0.001). Conclusion: This study confirmed, among other predictive characteristics, that PreOPWD is a powerful independent predictor of POAF. Keywords: Atrial fibrillation, Coronary artery bypass, Off-pump, Cohort studies, Meta-analysi