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. 1998 Nov;80(5):467–472. doi: 10.1136/hrt.80.5.467

Prediction of the onset of atrial fibrillation after cardiac surgery using the monophasic action potential

A Pichlmaier 1, V Lang 1, W Harringer 1, B Heublein 1, M Schaldach 1, A Haverich 1
PMCID: PMC1728842  PMID: 9930046

Abstract

Objective—To show that the monophasic action potential (MAP) recorded continuously from human epicardium may be used to predict the imminent onset of atrial fibrillation or flutter (AF) following surgery, thus allowing prophylactic treatment to be started.
Patients—22 patients (14 male, 8 female; mean (SD) age 64 (12) years) undergoing aortic valve replacement.
Setting—Tertiary referral centre.
Methods—Over a mean observation period of 8 (2.7) days (range 4 to 14), nine episodes of AF were seen in six patients. Before AF, specific and significant alterations of the MAP morphology were observed. In seven of nine episodes the MAP shortened (25 (4)% 60 minutes before AF), developed a triangular shape, and the plateau amplitude decreased from 5.3 (1.2) to 2 (0.2) mV. In the two remaining episodes the beat to beat variability of cycle length and MAP duration at 90% repolarisation (MAPd90) increased significantly from 24 (7) ms and 12 (8) ms (24 hours before AF) to 137 (27) ms and 56 (11) ms (30 minutes before AF) respectively. AF was successfully treated by the administration of sotalol in three cases and by a combination of verapamil and digoxin in a further four. Previously observed changes of MAPd90 and MAP morphology regressed after conversion to sinus rhythm.
Conclusions—The continuous and intermediate term recording of the MAP from atrial epicardium appears to be a valid tool for detecting imminent AF after cardiac surgery with a high sensitivity (99%) and specificity (88%). Optimised antiarrhythmic treatment may thus be given selectively for prophylaxis.

 Keywords: postoperative atrial fibrillation;  monophasic action potential;  postoperative management;  prophylactic antiarrhythmic treatment;  arrhythmias

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Figure 1  .

Figure 1  

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Atrial monophasic action potential (MAP) parameters analysed using the semiautomatic evaluation program. MAPd90 = MAP at 90% repolarisation.

Figure 2  .

Figure 2  

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Atrial monophasic action potential before the onset of atrial fibrillation (AF).

Figure 3  .

Figure 3  

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Changes in cycle length and monophasic action potential (MAP) duration variability and their linear correlation with the time interval before the onset of atrial fibrillation or flutter (AF). Error bars = SD. ΔCL, cycle length variability, ΔMAPd90, variability of monophasic action potential duration at 90% repolarisation.

Figure 4  .

Figure 4  

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Atrial monophasic action potential morphology before atrial fibrillation.

Figure 5  .

Figure 5  

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Atrial monophasic action potential morphology after the conversion of atrial fibrillation to sinus rhythm.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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