Preoperative alterations in correlation properties and complexity of R-R interval dynamics predict the risk of atrial fibrillation after coronary artery bypass grafting in patients with preserved left ventricular function

Introduction: We evaluated whether there are constant preoperative alterations in nonlinear R–R interval dynamics that associate with the risk of postoperative atrial fibrillation in patients with preserved left ventricular function. Methods: We analyzed mean normal‐to‐normal R–R intervals, short‐term scaling exponent of detrended fluctuation analysis (DFA α₁), approximate entropy and entropy of symbolic dynamics (SymDyn En) from 10‐minute ECG recordings during rest, paced breathing, and passive tilt performed 1 day before surgery in 67 elective coronary artery bypass grafting patients. Results: Nineteen patients developed postoperative atrial fibrillation. The preoperative DFA α₁ was constantly lower in patients developing postoperative atrial fibrillation than in patients remaining in sinus rhythm (P = 0.016); during spontaneous breathing, the DFA α₁ was 0.93 ± 0.33 in patients with atrial fibrillation and 1.13 ± 0.24 in patients with sinus rhythm. The entropy of symbolic dynamics was higher during the spontaneous breathing in patients with atrial fibrillation than in patients with sinus rhythm (4.72 ± 0.51 vs 4.36 ± 0.51, P = 0.012). Higher short‐term scaling exponent of detrended fluctuation analysis during the spontaneous breathing period reduced the risk of postoperative atrial fibrillation (OR 0.31 for an interquartile increase in DFA α₁, 95% CI 0.13–0.78), while higher entropy of symbolic dynamics increased it (OR 3.16 for an interquartile increase in SymDyn En, 95% CI 1.23–8.10), independently of age and clinical risk factors. Conclusion: The preoperatively altered nonlinear R–R interval dynamics were independent predictors of postoperative atrial fibrillation and might become a useful tool for the risk assessment of atrial fibrillation.