Atrial myxoma surgery and P-wave remodeling

Pacing Clin Electrophysiol. 2022 Sep;45(9):1160-1164. doi: 10.1111/pace.14573. Epub 2022 Aug 16.

Abstract

Introduction: Data regarding atrial electrocardiographic parameters in patients with atrial myxomas are scarce.

Methods: We aimed to study atrial electrocardiographic features in patients with atrial myxomas, before and after surgery. We also analyze the incidence of atrial fibrillation during follow-up and its correlation with different P-wave indexes. In total 32 patients in sinus rhythm that underwent atrial myxoma surgery were included.

Results: Mean age was 55.0 ± 12.6 years and 18 (56.3%) were women. Ten patients had left atrial enlargement (31.3%). Only one myxoma was located in the right atrium. At baseline seven cases of partial interatrial block (IAB) were detected (21.9%), two in the absence of left atrial enlargement. There were significant differences in atrial electrocardiographic indexes before and after surgery, including P-wave duration (108.9 ± 17.9 ms vs. 93.0 ± 12.4 ms; p < .001), partial IAB (21.9% vs. 3.1%; p = .012) and duration of P-wave terminal force in lead V1 negativity (-0.6 ± 0.3 vs. -0.5 ± 0.3 mm; p = .034). At a mean follow-up of 10.0 ± 5.5 years, 10 patients (31.3%) had experienced at least one episode of atrial fibrillation. Post-operative P-wave duration was associated with atrial fibrillation occurrence during follow-up (Hazard ratio: 0.90, 95% confidence interval: 0.83-0.98; p = .020).

Conclusions: Abnormalities in atrial electrocardiographic indexes are common in atrial myxomas and frequently improve after surgery. Post-operative P-wave duration is associated with atrial fibrillation occurrence during follow-up.

Keywords: P-wave; cardiac surgery; cardiac tumor; interatrial block; myxoma.

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation*
  • Electrocardiography
  • Female
  • Heart Atria / surgery
  • Heart Neoplasms* / complications
  • Heart Neoplasms* / surgery
  • Humans
  • Male
  • Middle Aged
  • Myxoma* / complications
  • Myxoma* / surgery