Cw. Hogue et al., RR INTERVAL DYNAMICS BEFORE ATRIAL-FIBRILLATION IN PATIENTS AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY, Circulation, 98(5), 1998, pp. 429-434
Citations number
42
Categorie Soggetti
Peripheal Vascular Diseas",Hematology,"Cardiac & Cardiovascular System
Background-Atrial fibrillation/flutter (AF) is a frequent complication
of coronary artery bypass graft surgery (CABG) that leads to increase
d costs and morbidity. We hypothesized that heart rate variability (HR
V), an indicator of cardiac sympathovagal balance, is altered before t
he onset of postoperative AF. Because nonlinear methods of HRV analysi
s provide information about heart rate dynamics not evident from usual
HRV measures, we also hypothesized that approximate entropy (ApEn), a
nonlinear measure of HRV, might have predictive value. Methods and Re
sults-Analysis of HRV was performed in 3 sequential 20-minute interval
s preceding the onset of postoperative AF (24 episodes in 18 patients)
. These data were compared with corresponding intervals in 18 sex- and
age-matched postoperative control subjects who did not develop AF. Pa
tients had left ventricular ejection fractions >45% before surgery and
were not receiving P-blockers during ambulatory ECG monitoring after
surgery. Logistic regression demonstrated that on the basis of average
d values for the three 20-minute intervals, increased heart rate and d
ecreased ApEn were independently associated with AF, Heart rate dynami
cs before AF was associated with either lower (n=19) or higher (n=5) R
R interval variation by traditional measures of HRV or quantitative Po
incare analysis, suggesting the possibility of divergent autonomic con
ditions before AF onset. Conclusions-In the hour before AF after CABG
surgery, higher heart rate and lower heart rate complexity compared wi
th values in control patients were independent predictors of AF. Decre
ased ApEn occurs in patients with either increased or decreased HRV by
traditional measures and may provide a useful tool for risk stratific
ation or investigation of mechanisms.