Review of methods to predict and detect atrial fibrillation in post-cardiac surgery patients

Atrial fibrillation (AF) is the most common sustained arrhythmia after cardiac surgery. Postoperative AF is known to substantially lengthen hospital stay and affect patient recovery. Identification of those at risk of developing AF after surgery and early detection of AF during recovery would be extremely helpful in effective management of these patients, including targeting prophylactic therapy to prevent AF in high-risk patients. In this communication, diagnostic methods to identify those at risk of developing AF after surgery and early identification of AF before, during, and after surgery have been reviewed. Signal-averaged P wave analysis, done before surgery, identifies patients who are likely to develop AF during recovery. When combined with low ejection fraction, signal-averaged P wave can discriminate those who develop AF from those who do not. During recovery, AF can be detected early either from a detailed analysis of atrial activity in a 10-second electrocardiogram or an analysis of R-to-R intervals from an extended rhythm strip (1 minute or longer). Analysis of the 10-second electrocardiogram includes median QRST subtraction from rhythm data and detection and analysis of atrial signals in the resulting residual. AF is detected from extended rhythm strips by using a statistical model to identify the presence of characteristic irregular patterns of R-to-R intervals.