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Prediction of postoperative atrial fibrillation using the electrocardiogram: A proof of concept
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Resumo(s)
Hospital patients recovering from major cardiac surgery are at high risk of postoperative
atrial fibrillation (POAF), an arrhythmia which can be life-threatening. With the development
of a tool to predict POAF early enough, the development of the arrhythmia could
be potentially prevented using prophylactic treatments, thus reducing risks and hospital
costs. To date, no reliable method suitable for autonomous clinical integration has been
proposed yet.
This thesis presents a study on the prediction of POAF using the electrocardiogram. A
novel P-wave quality assessment tool to automatically identify high-quality P-waves was
designed, and its clinical utility was assessed. Prediction of paroxysmal atrial fibrillation
(AF) was performed by implementing and improving a selection of previously proposed
methods. This allowed to perform a systematic comparison of those methods, and to test
if their combination improved prediction of AF. Finally, prediction of POAF was tested
in a clinically relevant scenario. This included studying the 48 hours preceding POAF,
and automatically excluding noise-corrupted P-waves using the quality assessment tool.
The P-wave quality assessment tool identified high-quality P-waves with high sensitivity
(0.93) and good specificity (0.84). In addition, this tool improved the ability to predict
AF, since it improved the precision of P-wave measurements. The best predictors of AF
and POAF were measurements of the variability in P-wave time- and morphological features.
Paroxysmal AF could be predicted with high specificity (0.93) and good sensitivity
(0.82) when several predictors were combined. Furthermore, POAF could be predicted
48 hours before its onset with good sensitivity (0.74) and specificity (0.70). This leaves
time for prophylactic treatments to be administered and possibly prevent POAF. Despite
being promising, further work is required for these techniques to be useful in the clinical
setting.
Descrição
Palavras-chave
Postoperative atrial fibrillation electrocardiogram P-wave prediction