Skip to main content
PMC home page
Annals of Noninvasive Electrocardiology logoLink to Annals of Noninvasive Electrocardiology
. 2006 Oct 27;7(3):211–218. doi: 10.1111/j.1542-474X.2002.tb00165.x

The Value of P Dispersion on Predicting Atrial Fibrillation After Coronary Artery Bypass Surgery: Effect of Magnesium on P Dispersion

Sinan Dagdelen 1,✉, Fevzi Toraman 2, Hasan Karabulut 2, Cem Alhan 1
PMCID: PMC7027776  PMID: 12167181

Abstract

Background: AF is a frequent arrhythmia complicating CABG, and it is well known that dispersion and prolongation of P wave increases the risk of AF. The aim of this study was to investigate the effect of magnesium (Mg) treatment on P‐wave duration and dispersion in patients undergoing CABG.

Method: The study included 148 consecutive patients (33 women, 115 men; mean age 62.1 ± 7.0 years) undergoing CABG who were randomly allocated to two groups. Group A consisted of 93 patients to whom 1.5 g daily MgSO4 infusion was applied the day before surgery, just after operation, and 4 days following surgery, and group B consisted of 55 control patients. From the preoperative and postoperative fourth day, 12‐lead ECG recordings, duration of the P waves, and P‐wave dispersions were calculated.

Results: There were no differences between the two groups with regard to age, sex, and blood Mg level. Comparison of the baseline and day 4 ECG measurements showed no difference as far as heart rates, duration of PQ, and QRS intervals were concerned. AF developed in 2 (2%) cases in group A and in 20 (36%) cases in group B (P < 0.001). There was no difference between the two groups when average basal P max, P min, P dispersion, and day 4 P min values were compared. In group A, fourth day P max (94.3 ± 11.8 vs 101.0 ± 13.2 ms; P = 0.0025) and P dispersion (38.2 ± 9.2 vs 44.9 ± 10.9 ms; P = 0.0002) were significantly lower as compared to group B. Comparing the patients who developed AF, and who did not, no difference was detected with regard to baseline P max, P min, P dispersion, and day 4 P min. Day 4 P max (95.1 ± 11.8 vs 106.4 ± 14.0 ms, P = 0.0015) and P dispersion (38.9 ± 8.8 vs 50.7 ± 13.0 ms, P = 0.001) of patients who developed AF were significantly higher. Baseline Mg levels were similar in patients who developed AF, and who did not, but the day 4 Mg level was significantly lower in AF group (2.0 ± 0.23 vs 2.15 ± 0.26 mg/dL, P < 0.001).

Conclusion: Perioperative Mg treatment reduces P dispersion and the risk of developing AF in patients undergoing CABG. A.N.E. 2002;7(3):211–218

Keywords: postoperative magnesium infusion, P dispersion, atrial fibrillation

REFERENCES

  • 1. Lauer MS, Eagle KA, Buckley MJ, et al. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis 1989;31:367–378. [DOI] [PubMed] [Google Scholar]
  • 2. Angelini P, Feldman MJ, Lutschanowski R. Cardiac arrhythmias during and after heart surgery: Diagnosis and management. Prog Cardiovasc Dis 1974;16:469–495. [DOI] [PubMed] [Google Scholar]
  • 3. Taylor GJ, Malik SA, Colliver JA. Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting. Am J Cardiol 1987;60:905–907. [DOI] [PubMed] [Google Scholar]
  • 4. Simpson RJ, Foster JR, Gettes LS. Atrial excitability and conduction in patients with interatrial conduction defects. Am J Cardiol 1982;50:1331–1337. [DOI] [PubMed] [Google Scholar]
  • 5. Klein M, Evans SJL, Blumberg S, et al. Use of P‐wavetriggered, P‐wave signal‐averaged electrocardiogram to predict atrial fibrillation after coronary artery bypass surgery. Am Heart J 1995;129:895–901. [DOI] [PubMed] [Google Scholar]
  • 6. Stafford PJ, Turner I, Vincent R. Quantitative analysis of signal‐averaged P waves in idiopathic paroxysmal atrial fibrillation. Am J Cardiol 1991;68:751–755. [DOI] [PubMed] [Google Scholar]
  • 7. Polychronis ED, Elias JG, Skevos KS, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–738. [DOI] [PubMed] [Google Scholar]
  • 8. Nurşzler F, Tokgşzoǧ L, Paşaoǧglu Y̌ et al. Atrial fibrillation after coronary bypass surgery: Predictions and the role of MgSOM4 replacement. J Cardiac Surg 1996;11:421–427. [DOI] [PubMed] [Google Scholar]
  • 9. Fanning WJ, Thomas CS, Roach A, et al. Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann Thorac Surg 1991;52:529–533. [DOI] [PubMed] [Google Scholar]
  • 10. Toraman F, Karabulut EH, Alhan HC, et al. Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg 2001;72:1256–1262. [DOI] [PubMed] [Google Scholar]
  • 11. Jensen BM, Alstrup P, Klitgard NA. Magnesium substitu tion and postoperative arrhythmias in patients undergoing coronary artery bypass grafting. Scand Cardiovasc J 1997;31:265–269. [DOI] [PubMed] [Google Scholar]
  • 12. Hnatkova K, Kulakowski P, Staunton A, et al. Influence of filtering technology and the time domain analysis, diagnosis and clinical use of signal‐averaged electrocardiogram. PACE 1994;17:1107–1117. [DOI] [PubMed] [Google Scholar]
  • 13. Breithardt G, Cain ME, El‐Sherif N, et al. Standards for analysis of ventricular late potentials using high‐resolution of signal‐averaged electrocardiography. Circulation 1991: 83:1481–1488. [DOI] [PubMed] [Google Scholar]
  • 14. Fukunami M, Yamada T, Ohmori M, et al. Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by p‐wave‐triggered signal‐averaged electrocar diogram. Circulation 1991;83:162–169. [DOI] [PubMed] [Google Scholar]
  • 15. Cresswell LL, Schuessler RB, Rosenbloom M, et al, Hazards of postoperative arrhythmias. Ann Thorac Surgery 1993;56: 539–549. [DOI] [PubMed] [Google Scholar]
  • 16. Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study). Am J Cardiol 1994;74:236–241. [DOI] [PubMed] [Google Scholar]
  • 17. Lauer MS, Eagle KA, Buckley MJ, et al. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis 1989;5:367–378. [DOI] [PubMed] [Google Scholar]
  • 18. Andrews TC, Reimold SC, Berlin JA, et al. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. Circulation 1991;84(Suppl. III):236–244. [PubMed] [Google Scholar]
  • 19. England MR, Gordon G, Salem M, et al. Magnesium administration and dysrhythmias after cardiac surgery‐ a placebo‐controlled, double‐blind, randomized trial. JAMA 1992;268:2395–2402. [PubMed] [Google Scholar]
  • 20. Fanning WJ, Thomas CS, Roach A, et al. Prophilaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann Thorac Surg 1991;52:529–533. [DOI] [PubMed] [Google Scholar]
  • 21. Zaman AG, Alamgir F, Richens T, et al. The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery. Heart 1997;77:527–531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Manners JM, Nielsen MS. Magnesium flux during open heart surgery. Anesthesia 1981;36:157–166. [DOI] [PubMed] [Google Scholar]
  • 23. Terzi A, Furlan G, Chiavacci P, et al. Prevention of atrial tachyarrhythmias after non‐cardiac thoracic surgery by infusion of magnesium sulfate. Thorac Cardiovasc Surg 1996;44:300–303. [DOI] [PubMed] [Google Scholar]
  • 24. Kshettry VR, Flavin TF, Emery RW, et al. Does multivessel, off‐pump coronary artery bypass procedure reduce postoperative morbidity Ann Thorac Surgery 2000;69:1725–1731. [DOI] [PubMed] [Google Scholar]
  • 25. Buxton AE, Josephson ME. The role of P wave duration as a predictor of postoperative atrial arrhythmias. Chest 1981;80:68–73. [DOI] [PubMed] [Google Scholar]
  • 26. Stafford PJ, Kolvekar S, Cooper J, et al. Signal averaged P wave compared with standard electrocardiography or echocardiography for prediction of atrial fibrillation after coronary bypass grafting. Heart 1997;77:417–422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Frost L, Lund B, Pilegaard H, et al. Re‐evaluation of the role of P‐wave duration and morphology as predictors of atrial fibrillation and flutter after coronary artery bypass surgery. Eur Heart J 1996;17:1065–1071. [DOI] [PubMed] [Google Scholar]
  • 28. Seifert M, Josephson ME. P‐wave signal averaging: High tech or an expensive alternative to standard ECG Circulation 1993;88:2980–2982. [DOI] [PubMed] [Google Scholar]
  • 29. Kubara I, Ikeda H, Horaki T, et al. Dispersion of filtered P wave duration by P wave signal‐averaged ECG mapping system: Its usefulness for determining efficacy of disopyramide on paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1999;10:670–679. [DOI] [PubMed] [Google Scholar]
  • 30. Spach MS, Dolber PC, Heidlage JF. Influence of the passive anisotropic properties on directional differences in propagation following modification of the sodium conductance on human atrial muscle: A model of reentry based on anisotropic discontinuous propagation. Circ Res 1988;62:811–832. [DOI] [PubMed] [Google Scholar]
  • 31. Watanabe Y, Dreifus LS. Electrophysiologcal effects of magnesium and its interaction with potassium. Cardiovasc Res 1972;6:79–88. [DOI] [PubMed] [Google Scholar]
  • 32. Bert AA, Reinert SE, Singh AK. A beta‐blocker, not magnesium, is effective prophylaxis for atrial tachyarrhythmias after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2001;15:204–209. [DOI] [PubMed] [Google Scholar]
  • 33. Parikka H, Toivonen L, Verkkala K, et al. The influence of intravenous magnesium sulphate on the occurrence of atrial fibrillation after coronary artery by‐pass operation. European Heart J 1993;14:251–258. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Noninvasive Electrocardiology are provided here courtesy of International Society for Holter and Noninvasive Electrocardiology, Inc. and Wiley Periodicals, Inc.

RESOURCES