Wireless Single-Lead ECG Monitoring to Detect New-Onset Postoperative Atrial Fibrillation in Patients After Major Noncardiac Surgery: A Prospective Observational Study

Johan D.V. Jokinen*, Christian J. Carlsson, Søren M. Rasmussen, Olav W. Nielsen, Bo G. Winkel, Lars N. Jorgensen, Michael P. Achiam, Jesper Mølgaard, Helge B.D. Sørensen, Eske K. Aasvang, Christian S. Meyhoff

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

4 Citationer (Scopus)

Abstract

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is associated with several cardiovascular complications and higher mortality. Several pathophysiological processes such as hypoxia can trigger POAF, but these are sparsely elucidated, and POAF is often asymptomatic. In patients undergoing major gastrointestinal cancer surgery, we aimed to describe the frequency of POAF as automatically estimated and detected via wireless repeated sampling monitoring and secondarily to describe the association between preceding vital sign deviations and POAF. METHOD: Patients ≥60 years of age undergoing major gastrointestinal cancer surgery were continuously monitored for up to 4 days postoperatively. Electrocardiograms were obtained every minute throughout the monitoring period. Clinical staff were blinded to all measurements. As for the primary outcome, POAF was defined as 30 consecutive minutes or more detected by a purpose-built computerized algorithm and validated by cardiologists. The primary exposure variable was any episode of peripheral oxygen saturation (Spo2) <85% for >5 consecutive minutes before POAF. RESULTS: A total of 30,145 hours of monitoring was performed in 398 patients, with a median of 92 hours per patient (interquartile range [IQR], 54-96). POAF was detected in 26 patients (6.5%; 95% confidence interval [CI], 4.5-9.4) compared with 14 (3.5%; 95% CI, 1.94-5.83) discovered by clinical staff in the monitoring period. POAF was followed by 9.4 days hospitalization (IQR, 6.5-16) versus 6.5 days (IQR, 2.5-11) in patients without POAF. Preceding episodes of Spo2<85% for >5 minutes (OR, 1.02; 95% CI, 0.24-4.00; P =.98) or other vital sign deviations were not significantly associated with POAF. CONCLUSIONS: New-onset POAF occurred in 6.5% (95% CI, 4.5-9.4) of patients after major gastrointestinal cancer surgery, and 1 in 3 cases was not detected by the clinical staff (35%; 95% CI, 17-56). POAF was not preceded by vital sign deviations.

OriginalsprogEngelsk
TidsskriftAnesthesia and Analgesia
Vol/bind135
Udgave nummer1
Sider (fra-til)100-109
Antal sider10
ISSN0003-2999
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
Conflicts of Interest: C. S. Meyhof is cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD project. WARD247 ApS has obtained license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes”. None of the above entities have influence on the study design, conduct, analysis or reporting. The author has also received direct and indirect departmental research funding from Boehringer Ingelheim and Merck, Sharp & Dohme, as well as lecture fees from Radiometer.

Funding Information:
Funding: The Wireless Assessment of Respiratory and circulatory Distress (WARD) project received core support from the Innovation Fund Denmark (8056-00055B), the Novo Nordic Foundation, the Danish Cancer Society (R150-A9865-16-S48), Steno Diabetes Center Denmark, Copenhagen Center for Health Technology (CACHET), Radiometer Medical Aps, Isansys Ltd, A. P. Møller Foundation, Bispebjerg Hospital, Rigshospitalet, and the Technical University of Denmark. No sponsor had any role in the study design, in the collection, analysis, and interpretation of data, nor in writing the report or the decision to submit the article. No sponsor had access to the study data.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

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