Combination of clinical and electrocardiographic indices to predict Cox-Maze surgery outcome at discharge

The most effective procedure to terminate atrial fibrillation (AF) is the Cox-Maze surgery. After the intervention, independently of patient's rhythm, all are treated with oral anticoagulants and antiarrhythmic drugs prior to discharge. Moreover, patients still in AF before discharge are treated with electrical cardioversion (ECV). Therefore, an early prognosis of patient's rhythm at discharge would help to plan in advance drug therapy and ECV decisions. This work studies clinical and ECG indices to predict patient's rhythm at discharge. For this purpose, 29 preoperative standard ECGs from patients in AF have been analyzed. The dominant atrial frequency, the sample entropy and the fibrillatory waves amplitude were obtained as ECG indices. Additionally, patient's age, preoperative AF duration and atrial size were added as clinical indices. Then, a classification tree combining clinical and ECG parameters has been generated to predict patient's rhythm at discharge, yielding a sensitivity, specificity and accuracy of 87.5%, 100% and 93.1% respectively. These results suggest that an accurate prediction of AF termination at discharge is possible.