Long-term single-lead electrocardiogram monitoring to detect new-onset postoperative atrial fibrillation in patients after cardiac surgery

BACKGROUND: Postoperative atrial fibrillation (POAF) is often associated with serious complications. In this study, we collected long-term single-lead electrocardiograms (ECGs) of patients with preoperative sinus rhythm to build statistical models and machine learning models to predict POAF. METHODS: All patients with preoperative sinus rhythm who underwent cardiac surgery were enrolled and we collected long-term ECG data 24 h before surgery and 7 days after surgery by single-lead ECG. The patients were divided into a POAF group a no-POAF group. A clinical model and a clinical + ECG model were constructed. The ECG parameters were designed and support vector machine (SVM) was selected to build a machine learning model and evaluate its prediction efficiency. RESULTS: A total of 100 patients were included. The detection rate of POAF in long-term ECG monitoring was 31% and that in conventional monitoring was 19%. We calculated 7 P-wave parameters, Pmax (167 ± 31 ms vs. 184 ± 37 ms, P = 0.018), Pstd (15 ± 7 vs. 19 ± 11, P = 0.031), and PWd (62 ± 28 ms vs. 80 ± 35 ms, P = 0.008) were significantly different. The AUC of the clinical model (sex, age, LA diameter, GFR, mechanical ventilation time) was 0.86. Clinical + ECG model (sex, age, LA diameter, GFR, mechanical ventilation time, Pmax, Pstd, PWd), AUC was 0.89. In the machine learning model, the accuracy (Ac) of the train set and test set was above 80 and 60%, respectively. CONCLUSION: Long-term ECG monitoring could significantly improve the detection rate of POAF. The clinical + ECG model and the machine learning model based on P-wave parameters can predict POAF.