Application of the preoperative ECG to predict Cox-Maze surgery mid-term outcome

The Cox-Maze surgery is today the procedure with the highest long-term cure rate for patients in atrial fibrillation (AF). Nonetheless, its mid-term outcome prediction could avoid the application of aggressive pharmacologic treatments in some patients. Previous works have revealed that parameters computed from the preoperative ECG, such as the fibrillatory waves amplitude (fWP), the dominant atrial frequency (DAF) and the sample entropy (SampEn), can identify successfully the Cox-Maze immediate outcome at discharge. This work focuses on analyzing the ability of these parameters to predict the patient's rhythm six months post-surgery. Results showed sensitivity, specificity and accuracy values of 71.43%, 52.94% and 58.33% for fWP, 85.71%, 52.94% and 62.5% for DAF and 85.71%, 58.82% and 66.66% for SampEn, respectively, reporting no statistically significant differences between patients in AF or normal rhythm. Therefore, in contrast to previous results, these metrics did not show to be significant predictors of the Cox-Maze surgery at mid-term. The atrial substrate alteration due to pharmacological and electrical cardioversion in patients relapsing to AF during the follow-up could be the main reason for this result. Further analyses are required to clarify this question.

[1]  Leo Breiman,et al.  Classification and Regression Trees , 1984 .

[2]  M. Paluš,et al.  Detecting nonlinearity and phase synchronization with surrogate data , 1998, IEEE Engineering in Medicine and Biology Magazine.

[3]  L. Sörnmo,et al.  Non-invasive assessment of the atrial cycle length during atrial fibrillation in man: introducing, validating and illustrating a new ECG method. , 1998, Cardiovascular research.

[4]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[5]  Fernando Hornero,et al.  Biatrial radiofrequency ablation for atrial fibrillation: epicardial and endocardial surgical approach. , 2002, Interactive cardiovascular and thoracic surgery.

[6]  Pablo Laguna,et al.  Bioelectrical Signal Processing in Cardiac and Neurological Applications , 2005 .

[7]  Ralph J. Damiano,et al.  Surgical treatment of atrial fibrillation: predictors of late recurrence. , 2005 .

[8]  Haitham M. Al-Angari,et al.  Atrial fibrillation and waveform characterization. A time domain perspective in the surface ECG. , 2006, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[9]  Haitham M. Al-Angari,et al.  Atrial fibrillation and waveform characterization , 2006, IEEE Engineering in Medicine and Biology Magazine.

[10]  Nader Moazami,et al.  A New Era in the Surgical Treatment of Atrial Fibrillation: The Impact of Ablation Technology and Lesion Set on Procedural Efficacy , 2006, Annals of surgery.

[11]  N. Gall,et al.  Electrical Cardioversion for AF—The State of the Art , 2007, Pacing and clinical electrophysiology : PACE.

[12]  J. J. Rieta,et al.  Adaptive singular value cancelation of ventricular activity in single-lead atrial fibrillation electrocardiograms , 2008, Physiological measurement.

[13]  Roberto Hornero,et al.  Optimal parameters study for sample entropy-based atrial fibrillation organization analysis , 2010, Comput. Methods Programs Biomed..

[14]  Raúl Alcaraz,et al.  A review on sample entropy applications for the non-invasive analysis of atrial fibrillation electrocardiograms , 2010, Biomed. Signal Process. Control..

[15]  Raúl Alcaraz,et al.  The application of nonlinear metrics to assess organization differences in short recordings of paroxysmal and persistent atrial fibrillation , 2010, Physiological measurement.

[16]  R. Alcaraz,et al.  Role of fibrillatory waves amplitude as predictors of immediate arrhythmia termination after Maze surgery of atrial fibrillation , 2012, 2012 Computing in Cardiology.

[17]  Jeroen J. Bax,et al.  2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. , 2012, European heart journal.

[18]  Gerhard Hindricks,et al.  2012 Focused Update of the ESC Guidelines for the Management of Atrial Fibrillation , 2013 .