Atrial Electrography for Postoperative Tachyarrhythmia Analysis in Patients.

MATTHEW KALSCHEUR,ASHLEY PEOTTER,NICHOLAS VON BERGEN,DIANNE BROWN

doi:10.19102/icrm.2021.121003

Abstract

The over 400,000 cardiac surgeries performed in the United States each year hold a risk for the postoperative complication of arrhythmias. Currently, bedside monitoring of surface electrocardiogram leads is used to interpret arrhythmias despite the evidence that atrial electrograms (AEGs) offer superior rhythm discrimination. This hesitancy to use the AEG may be due to a lack of training for practitioners in interpreting AEGs; therefore, our goal was to create an algorithm for the diagnosis of tachyarrhythmia using an AEG that can be utilized by any health care practitioner. Our algorithm classifies the most prevalent type of tachyarrhythmias following cardiac surgery. To allow rhythm identification, we categorized them based on their atrial to ventricular signal ratio, which is uniquely apparent on AEGs. Other considerations were given to rhythm regularity, consistency, P-wave axis, and rate. The algorithm includes the most common postoperative arrhythmias differentiated based on a unique branch-point approach, which walks through the steps in arrhythmia discrimination. Both rendered and collected AEGs are included as references for further understanding and interpretation of tachyarrhythmias. The utility of AEGs for rhythm discrimination post-cardiac surgery is established and recent technology can provide real-time and continuous monitoring; however, practitioner training may be inadequate. To bridge this divide, we created an algorithm so that existing atrial wires can be better used for an enhanced rhythm interpretation via AEGs.

Highlights

Postoperative arrhythmias remain a significant risk for over 400,000 patients who undergo cardiac surgeries in the United States each year.[1]
Though the atrial signals generally appear irregular on the surface electrogram, they may appear more uniform on an atrial electrograms (AEGs)
Multifocal atrial tachycardia (MAT) typically has an irregular atrial rate, an irregular ventricular rate, and a variable P-wave morphology, often interspersed with periods of sinus rhythm (Figure 20). This arrhythmia is due to multiple sites of automaticity within the atrium resulting in variable atrial signals and P-wave morphology

Summary

Introduction

Postoperative arrhythmias remain a significant risk for over 400,000 patients who undergo cardiac surgeries in the United States each year.[1]. Adenosine blocks AV nodal conduction resulting in the termination of AV node–dependent arrhythmias [AVRT, AVNRT, atypical AVNRT, permanent junctional reciprocating tachycardia (PJRT)] It can terminate some automatic rhythms, such as some AETs and some VTs. As discussed already, in an arrhythmia with 1:1 conduction, if adenosine blocks AV nodal conduction and the arrhythmia is not terminated, the resulting arrhythmia (with more atrial than ventricular or more ventricular than atrial signals) can be used to diagnose the arrhythmia. We discuss the individual appearance of the AEG in each arrhythmia type and their typical rate, behavior, and response to adenosine and/or atrial overdrive pacing We include both an idealized figure of the AEG during the arrhythmia as well as patient examples when. The ECGs are displayed with a standard sweep speed of 25 mm/s

Background

Discussion

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Conclusion