The purpose of this study is to characterize conducted premature atrial contractions (PACs) that occur prior to the onset of postoperative atrial fibrillation (PAF) as an indicator of high probability of developing PAF.
A computer algorithm was developed to detect conducted PACs. To validate the algorithm, signals were randomly selected from collected ECG data. A staff cardiologist (OW) manually annotated conducted PACs. The 2-channel PAC detection algorithm was applied to the same set of signals to compare it to manual detection. The algorithm detected PACs with 91(±9)% accuracy. Twenty-four patients who underwent cardiac surgey and developed PAF were identified. The PAC detection algorithm was applied to analyze PAC patterns in these patients.
Of the 24 patients who developed PAF, 21(87.5%)had PACs prior to the onset of PAF. These patients showed either a pattern of sustained uniform PAC activity (fig.1) or spontaneous bursts of high PAC activity interspaced with relatively quiet periods of PAC activity (fig. 2).
In this study, PACs were identified and characterized in patients who developed PAF. There were two patterns of PAC activity prior to the onset of PAF. Either pattern, or both in combination, might be an antecedent pattern that indicates a high probability of new-onset PAF.
If characterisic PAC patterns are shown to reliably predict PAF, pharmacologic interventions with agents used to treat PAF could be initiated when the characterisitc PAC pattern is first detected, and be continued during the highest PAF risk period (postoperative days 1 - 5) to decrease the incidence of this morbid postoperative complication. The clinical objective is that if the onset of PAF can be reliably predicted, PAF might be preventable in certain cases.
C.A. Bashour, None.