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Heart 1998;80:467-472 ( November )
a Department of Thoracic and
Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Stra
e,
30625 Hannover, Germany, b Department of Biomedical
Engineering, Friedrich-Alexander University, Erlangen, Germany
Correspondence to: Dr med Pichlmaier.
Accepted for publication 30 June 1998
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.
Patients22 patients (14 male, 8 female;
mean (SD) age 64 (12) years) undergoing aortic valve replacement.
SettingTertiary referral centre.
MethodsOver 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.
ConclusionsThe 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.
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