Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients
<i>Background and Objectives:</i> Postoperative atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG), and is particularly associated with poor outcomes. Heart rate variability (HRV), a non-invasive marker of autonomic function, has been propose...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-05-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/61/6/984 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850167793581817856 |
|---|---|
| author | Juš Kšela Jan Kafol Viktor Avbelj Jurij Matija Kališnik |
| author_facet | Juš Kšela Jan Kafol Viktor Avbelj Jurij Matija Kališnik |
| author_sort | Juš Kšela |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Postoperative atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG), and is particularly associated with poor outcomes. Heart rate variability (HRV), a non-invasive marker of autonomic function, has been proposed as a tool to predict AF risk, but its utility in off-pump CABG remains unclear. This study aimed to evaluate the predictive value of preoperative HRV parameters, including nonlinear metrics, for postoperative AF in patients undergoing off-pump CABG. <i>Materials and Methods</i>: We prospectively enrolled 67 patients undergoing elective off-pump CABG. HRV was assessed using 15 min high-resolution ECGs. Linear and nonlinear HRV parameters were analyzed. Postoperative AF was monitored through continuous ECG (days 0–4), daily 12-lead ECGs (days 5–7), and a 24 h Holter ECG on day 7. Statistical comparisons between AF and non-AF groups were performed, and the predictive accuracy was evaluated using ROC analysis. <i>Results</i>: Postoperative AF occurred in 40.3% (n = 27) of patients. Standard HRV measures (total power, frequency components, LF/HF ratio) did not differ significantly between groups. However, preoperative DFA Alpha 1 was significantly lower in patients who developed AF (<i>p</i> = 0.010) and showed the highest predictive value (AUC = 0.725, specificity = 80%). Alpha 1 also remained significantly reduced postoperatively in the AF group. Other nonlinear parameters, such as low and average fractal dimension, were also lower postoperatively in the AF group. <i>Conclusions</i>: Traditional HRV parameters showed limited predictive value for postoperative AF following off-pump CABG. The nonlinear DFA Alpha 1 index demonstrated a moderate predictive performance and may serve as a useful marker of autonomic dysregulation. Incorporating nonlinear HRV measures into preoperative assessment may improve AF risk stratification. |
| format | Article |
| id | doaj-art-b08356de61e24eb4993121bd6764569d |
| institution | OA Journals |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-b08356de61e24eb4993121bd6764569d2025-08-20T02:21:07ZengMDPI AGMedicina1010-660X1648-91442025-05-0161698410.3390/medicina61060984Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass PatientsJuš Kšela0Jan Kafol1Viktor Avbelj2Jurij Matija Kališnik3Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, 1000 Ljubljana, SloveniaDepartment of Communication Systems, Jožef Stefan Institute, 1000 Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia<i>Background and Objectives:</i> Postoperative atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG), and is particularly associated with poor outcomes. Heart rate variability (HRV), a non-invasive marker of autonomic function, has been proposed as a tool to predict AF risk, but its utility in off-pump CABG remains unclear. This study aimed to evaluate the predictive value of preoperative HRV parameters, including nonlinear metrics, for postoperative AF in patients undergoing off-pump CABG. <i>Materials and Methods</i>: We prospectively enrolled 67 patients undergoing elective off-pump CABG. HRV was assessed using 15 min high-resolution ECGs. Linear and nonlinear HRV parameters were analyzed. Postoperative AF was monitored through continuous ECG (days 0–4), daily 12-lead ECGs (days 5–7), and a 24 h Holter ECG on day 7. Statistical comparisons between AF and non-AF groups were performed, and the predictive accuracy was evaluated using ROC analysis. <i>Results</i>: Postoperative AF occurred in 40.3% (n = 27) of patients. Standard HRV measures (total power, frequency components, LF/HF ratio) did not differ significantly between groups. However, preoperative DFA Alpha 1 was significantly lower in patients who developed AF (<i>p</i> = 0.010) and showed the highest predictive value (AUC = 0.725, specificity = 80%). Alpha 1 also remained significantly reduced postoperatively in the AF group. Other nonlinear parameters, such as low and average fractal dimension, were also lower postoperatively in the AF group. <i>Conclusions</i>: Traditional HRV parameters showed limited predictive value for postoperative AF following off-pump CABG. The nonlinear DFA Alpha 1 index demonstrated a moderate predictive performance and may serve as a useful marker of autonomic dysregulation. Incorporating nonlinear HRV measures into preoperative assessment may improve AF risk stratification.https://www.mdpi.com/1648-9144/61/6/984atrial fibrillationheart rate variabilityDFA Alpha 1coronary artery bypass grafting |
| spellingShingle | Juš Kšela Jan Kafol Viktor Avbelj Jurij Matija Kališnik Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients Medicina atrial fibrillation heart rate variability DFA Alpha 1 coronary artery bypass grafting |
| title | Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients |
| title_full | Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients |
| title_fullStr | Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients |
| title_full_unstemmed | Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients |
| title_short | Predictive Value of Heart Rate Variability for Postoperative Atrial Fibrillation in Off-Pump Coronary Artery Bypass Patients |
| title_sort | predictive value of heart rate variability for postoperative atrial fibrillation in off pump coronary artery bypass patients |
| topic | atrial fibrillation heart rate variability DFA Alpha 1 coronary artery bypass grafting |
| url | https://www.mdpi.com/1648-9144/61/6/984 |
| work_keys_str_mv | AT jusksela predictivevalueofheartratevariabilityforpostoperativeatrialfibrillationinoffpumpcoronaryarterybypasspatients AT jankafol predictivevalueofheartratevariabilityforpostoperativeatrialfibrillationinoffpumpcoronaryarterybypasspatients AT viktoravbelj predictivevalueofheartratevariabilityforpostoperativeatrialfibrillationinoffpumpcoronaryarterybypasspatients AT jurijmatijakalisnik predictivevalueofheartratevariabilityforpostoperativeatrialfibrillationinoffpumpcoronaryarterybypasspatients |