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.

中文翻译：

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无线单导联心电图监测检测重大非心脏手术后患者新发术后心房颤动：一项前瞻性观察研究

背景： 

术后新发心房颤动 (POAF) 与多种心血管并发症和较高的死亡率相关。缺氧等多种病理生理过程可引发 POAF，但目前对这些过程的阐明很少，而且 POAF 常常无症状。在接受重大胃肠癌手术的患者中，我们的目的是描述通过无线重复采样监测自动估计和检测的 POAF 频率，其次描述先前生命体征偏差与 POAF 之间的关联。

方法： 

对接受重大胃肠道癌症手术的年龄≥60岁的患者进行术后持续监测长达4天。在整个监测期间每分钟获得一次心电图。临床工作人员对所有测量结果均不知情。至于主要结果，POAF 被定义为由专用计算机算法检测到的连续 30 分钟或更长时间，并由心脏病专家验证。主要暴露变量是POAF 前连续 5 分钟以上外周血氧饱和度 (Sp o _{2 ) <85% 的任何发作。}

结果： 

对 398 名患者进行了总共 30,145 小时的监测，每名患者的中位监测时间为 92 小时（四分位距 [IQR]，54-96）。26 名患者（6.5%；95% 置信区间 [CI]，4.5-9.4）检测到 POAF，而临床工作人员在监测期间发现了 14 名患者（3.5%；95% CI，1.94-5.83）。POAF 后住院 9.4 天（IQR，6.5-16），而没有 POAF 的患者则住院 6.5 天（IQR，2.5-11）。之前的 Sp o ₂ <85% 持续 >5 分钟（OR，1.02；95% CI，0.24-4.00；P = .98）或其他生命体征偏差与 POAF 没有显着相关性。

结论： 

6.5% (95% CI, 4.5-9.4) 的胃肠道癌症手术后新发 POAF 患者发生，三分之一的病例未被临床工作人员发现 (35%; 95% CI, 17-56)。POAF 之前没有出现生命体征偏差。