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patients were monitored with continuous ECG telemetry for ≥2 weeks following MVS. The current study was able to detect new-onset of AF without fail compared with previous reports.6–8 Secondly, under univariate analysis of prediction for postoperative AF, a degenerative MR, the duration of MR, A-wave peak velocity, PA-TDI duration and preoperative CVP were significant predictors of postoperative AF. Multivariate analysis demonstrated that degenerative MR (95% confidence interval (CI): 1.41–15, P=0.0112) and PA-TDI duration (95% CI: 1.01–1.07, P=0.0048) were significant and independent predictors of postoperative AF. The reason for the poor association of LA volume parameters and postoperative AF in this study was the larger LA volume in both the AF and non-AF groups (LA volume index, AF 58.7±20.6 ml/m2 vs. Non-AF 53.4±16.2 ml/m2 P=0.27). The current results were a little different from previous reports analyzing patients after off-pump CABG11 or AVR.12 Multivariate analysis demonstrated that postoperative AF after ulnerability to atrial fibrillation (AF) associates the atrial condition with the critical number of wavelets and multiple reentrant circuits resulting in delayed intra-atrial conduction.1,2 Total atrial conduction time (TACT), representing the total time required for atrial electrical activation, can be evaluated as the maximal P-wave duration using single-averaged electrocardiogram (SA-ECG), and is reported to be a powerful predictor of AF.3,4 However, this method of measuring TACT is difficult to use in clinical practice because of its time-consuming technique and requirement for special hardware. Merckx et al described an alternative echocardiographic measurement using tissue Doppler imaging (TDI) to estimate TACT. They measured the time from the initiation of atrial depolarization represented by the onset of the P-wave on the 12-lead surface ECG (lead II) until the last atrial depolarization represented by the peak of TDI A’ wave at the left atrial (LA) lateral wall (Figure). They also demonstrated that this TDI-derived atrial conduction time (PA-TDI duration) using echocardiography equipment5 had the best correlation with TACT measured by SA-ECG. Furthermore, PA-TDI duration also enables practical and better prediction of new-onset AF,6 recurrence after AF ablation7 and AF after acute myocardial infarction8 compared with LA volume or other parameters.

Usefulness of Tissue Doppler Imaging-Derived Atrial Conduction Time for Prediction of Atrial Fibrillation