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Atrial FibrillationNCT03962166

Characterizing Patients With POAF in Relation to Cardiac Surgery by wavECG and TTE

An observational study of Atrial Fibrillation and Left Ventricular Diastolic Dysfunction, run by Helena DOMINGUEZ at 1 site in Denmark.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Post-operative atrial fibrillation (POAF) is frequently observed after open-heart surgery. Despite numerous attempts to predict POAF, it remains a challenge to correctly identify the patients at risk. New technologies are available but not yet in cooperated in clinical guidelines and prediction models. Read more about this study

Who is it for?
Ages 18 years and older
How many people
353 participants
Where
1 siteDenmark
Study dates
7 Oct 2019to 31 Dec 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Consecutive adult patients undergoing first-time elective open-heart surgery at Department of Cardiothoracic Surgery at Copenhagen University Hospital not fulfilling any exclusion criteria and who have signed informed consent

Who may be able to join

  • Age >18 years
  • First time open-heart surgery
  • Coronary artery bypass grafting and/or valve surgery
  • Signed informed consent

Who cannot join

  • Planned closure of the left atrial appendage
  • Planned ablation for atrial fibrillation during surgery
  • Ongoing inflammation or infection (including endocarditis)
  • Connective tissue disease
  • Ongoing cancer (not control)
  • Pregnancy
  • Follow-up not possible

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Cardiology department Y, Bispebjerg-Frederiksberg Hospital

    Frederiksberg, 2000

Other trials in Denmark

About this study

Official title: Characterizing Patients With Post-operative Atrial Fibrillation in Relation to Cardiac Surgery by Signal Processed Surface Electrocardiogram (wavECG) and Transthoracic Echocardiography A LAACS-2 Sub-study

Post-operative atrial fibrillation (POAF) is frequently observed after open-heart surgery. Despite numerous attempts to predict POAF, it remains a challenge to correctly identify the patients at risk. New technologies are available but not yet in cooperated in clinical guidelines and prediction models. We aim at identifying patients at risk of AF occurrence/recurrence after open-heart surgery by use of signal processed surface ECG (wavECG).

The study is an explorative, prospective cohort study of 100 patients undergoing first-time elective open-heart surgery in the Left Atrial Appendage Closure by Surgery-2 (LAACS-2) trial (NCT03724318). Patients are examined by electrocardiogram (ECG), wavECG, transthoracic echocardiography and continuous heart rhythm monitoring. Primary endpoint is occurrence/recurrence of AF. Left ventricular diastolic dysfunction as evaluated by wavECG will be used to predict incidence of primary endpoint.

Read the detailed description

Introduction: Post-operative atrial fibrillation (POAF) is frequently observed after open-heart surgery,1-3 and atrial fibrillation (AF) is frequently complicated by stroke.4-6 During AF, the electrical activity is uncoordinated and the atrial contraction is reduced, increasing the risk of thrombi formation. Subsequently, the thrombi can enter the general circulation, reach the small intracerebral arteries and block blood flow resulting in ischaemic damage.5,7 Anti-coagulant medicines efficiently prevent ischaemic strokes,8 however many patients are asymptomatic or have vague symptoms why diagnosis can be difficult to obtain.5 Furthermore, AF that occurs secondarily to surgery is currently considered self-limiting and continuous anti-coagulation is not necessarily recommended.4,9 However, cumulating evidence suggest that secondary AF in patients with known heart disease increases the long-term risk of stroke and transitory ischaemic attack, recurrent AF and mortality.10-15 In patients undergoing coronary artery bypass grafting (CABG) new-onset AF is associated with increased long-term risk of stroke and mortality compared to patients without AF.14,15 Though there are well-established risk factors for AF, such as age, arterial hypertension, heart failure, myocardial infarction, heart valve disease and diabetes mellitus, the pathophysiology of AF is complex and not fully understood.6,16,17 Both structural remodelling of the atria and electrical pathways, as well as oxidative stress, calcium overload, myofibroblast activation, microRNAs and inflammation, are mentioned as possible factors involved in initiation and progression of AF.6,16-18 Attempts to create and improve risk stratification models for AF and stroke has previously been done, both in community based cohorts and patients undergoing cardiac surgery, e.g. CHA2DS2-VASC, FHS AF risk score, ARIC risk prediction tool, CHARGE-AF risk model, HAVOC score, SYNTAX score, POAF score and POAF prediction model.19-27 However, it remains challenging to accurately predict occurrence of AF both perioperatively and in the subsequent years.28,29

A recent systematic review and meta-analysis concluded that p-wave terminal force in lead V1 (PTFV1), p-wave duration and maximum p-wave area, are all correlated with stroke,30 and a recent review similarly suggest that short and prolonged p-wave and PTFV1 is correlated with AF.31 sp-ECG by Myovista (Southlake, Texas, USA) is a novel advanced ECG utilizing continues wavelet transform signal processing and can detect left ventricular diastolic dysfunction (LVDD) which is associated with AF and post-operative heart failure in other studies.17,32-35 LA strain and E/LA strain indices predicted new cardiovascular events including strokes, in a stroke population36 In patients undergoing catheter ablation for AF, LA strain can identify patients at risk of AF recurrence37,38 POAF has furthermore been predicted in a cohort of patients with severe aortic stenosis by LA strain indexes.39

Aim: We aim at characterizing patients with AF occurrence by novel, easy, and accessible methods such as electrocardiogram (ECG), signal processed surface ECG (Myovista, wavECG) and transthoracic echocardiography (TTE).

Methods: Explorative, prospective cohort study of adult patients undergoing first-time elective open-heart surgery at Department of Cardiothoracic Surgery at Copenhagen University Hospital, Rigshospitalet. One hundred consecutive patients enrolled in the Left Atrial Appendage Closure by Surgery-2 (LAACS-2) trial (NCT03724318) fulfilling the inclusion/exclusion criteria are included in the current study.

The study is approved by the Regional Committee on Health Research Ethics and all procedures followed are in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration. All patients have signed informed consent prior to study enrolment.

Study timeline: One day prior to surgery; patient charts are reviewed, and ECG, wavECG and TTE are obtained. Anaesthesiologists will report AF occurred during intra-operative cardiac monitoring. Post-surgery cardiac rhythm monitoring is applied for at least 48 hours. At discharge patient charts and monitoring are reviewed for any occurrence of new-onset AF. Three months after surgery, patient charts are reviewed, and patients are invited for a single visit at Department of Cardiology at Frederiksberg hospital, where a control ECG, wavECG and TTE are performed. Deviation of the examination programme is accepted, i.e. patients can decline parts of the pre- or post-surgery examinations and remain in the study for follow-up.

Statistics: Precise sample size calculations are not applicable in this explorative study with LVDD in sp-ECG as primary end-point. One previous study has been performed where wavECG identified patients with LVDD in a population (n=188) referred for computed tomography coronary angiography.32 LA strain measured by TTE predicted POAF in 26 of 60 patients undergoing open-heart surgery for severe aortic stenosis.39 P-wave indices from pre-operative ECGs have predicted POAF in a population of 105 cardiac surgery patients.40 The study will include 100 consecutive patients undergoing open-heart surgery. Expected distribution of patients are n=10 for pre-surgery AF (corresponding to the incidence in the background population 1%6), POAF n= 35-50 (corresponding to the incidence in previous cardiac surgery populations; 35-50%1-3), and non-AF n=40-55 (remaining population). Follow-up will be three months.

Parametric statistics is used as normal distribution is expected (e.g. two-sample unpaired Student's t-test) and data is presented with mean ± standard deviation. All tests are two-sided and a P-value < 0.05 is considered statistically significant. IBM SPSS version 22 will be used for statistical analyses.

Keywords
atrial fibrillation, left ventricular diastolic dysfunction, electrocardiogram, signal processed surface ECG, wavECG, transthoracic echocardiography
Medical subject headings
Atrial Fibrillation, Ventricular Dysfunction, Left

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT03962166
Study groupRoleWhat they receive
Cohortconsecutive adult patients undergoing first-time elective open-heart surgery

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Atrial fibrillation

    Occurence/recurrence of atrial fibrillation

    Measured: before discharge within two weeks after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 May 2019
  2. Study start7 Oct 2019
  3. Primary completion30 Dec 2023
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
353 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03962166
Sponsor's protocol ID
H-17033253-S1
Status last verified
Jan 2026
First submitted
1 May 2019
Last updated
16 Jan 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: De-identified individual patient data for primary and secondary outcomes measures will be made available upon reasonable request.

Publications

  • Ahlsson A, Fengsrud E, Bodin L, Englund A. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. Eur J Cardiothorac Surg. 2010 Jun;37(6):1353-9. doi: 10.1016/j.ejcts.2009.12.033.

    PubMed 20138531
  • Pillarisetti J, Patel A, Bommana S, Guda R, Falbe J, Zorn GT, Muehlebach G, Vacek J, Sue Min Lai, Lakkireddy D. Atrial fibrillation following open heart surgery: long-term incidence and prognosis. J Interv Card Electrophysiol. 2014 Jan;39(1):69-75. doi: 10.1007/s10840-013-9830-6. Epub 2013 Nov 29.

    PubMed 24293173
  • Lee SH, Kang DR, Uhm JS, Shim J, Sung JH, Kim JY, Pak HN, Lee MH, Joung B. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft. Am Heart J. 2014 Apr;167(4):593-600.e1. doi: 10.1016/j.ahj.2013.12.010. Epub 2014 Jan 4.

    PubMed 24655710
  • Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH; ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010 Oct;12(10):1360-420. doi: 10.1093/europace/euq350. No abstract available.

    PubMed 20876603
  • Healey JS, Crystal E, Lamy A, Teoh K, Semelhago L, Hohnloser SH, Cybulsky I, Abouzahr L, Sawchuck C, Carroll S, Morillo C, Kleine P, Chu V, Lonn E, Connolly SJ. Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J. 2005 Aug;150(2):288-93. doi: 10.1016/j.ahj.2004.09.054.

    PubMed 16086933
  • January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):e199-267. doi: 10.1161/CIR.0000000000000041. Epub 2014 Mar 28. No abstract available.

    PubMed 24682347
  • Dawson AG, Asopa S, Dunning J. Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):306-11. doi: 10.1510/icvts.2009.227991. Epub 2009 Nov 26.

    PubMed 19942634
  • Aguilar MI, Hart R. Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2005 Jul 20;2005(3):CD001927. doi: 10.1002/14651858.CD001927.pub2.

    PubMed 16034869
  • Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC Jr, Darbar D, Wee JO, Waddell TK, Amar D, Adler D; American Association for Thoracic Surgery. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014 Sep;148(3):e153-93. doi: 10.1016/j.jtcvs.2014.06.036. Epub 2014 Jun 30. No abstract available.

    PubMed 25129609
  • Siu CW, Jim MH, Ho HH, Miu R, Lee SW, Lau CP, Tse HF. Transient atrial fibrillation complicating acute inferior myocardial infarction: implications for future risk of ischemic stroke. Chest. 2007 Jul;132(1):44-9. doi: 10.1378/chest.06-2733. Epub 2007 Mar 30.

    PubMed 17400657
  • Bishara R, Telman G, Bahouth F, Lessick J, Aronson D. Transient atrial fibrillation and risk of stroke after acute myocardial infarction. Thromb Haemost. 2011 Nov;106(5):877-84. doi: 10.1160/TH11-05-0343. Epub 2011 Aug 25.

    PubMed 21866303
  • Zusman O, Amit G, Gilutz H, Zahger D. The significance of new onset atrial fibrillation complicating acute myocardial infarction. Clin Res Cardiol. 2012 Jan;101(1):17-22. doi: 10.1007/s00392-011-0357-5. Epub 2011 Sep 11.

    PubMed 21910032
  • Asanin MR, Vasiljevic ZM, Matic MD, Mrdovic IB, Perunicic JP, Matic DP, Vujisic-Tesic BD, Stankovic SD, Matic DM, Ostojic MC. The long-term risk of stroke in patients with acute myocardial infarction complicated with new-onset atrial fibrillation. Clin Cardiol. 2009 Aug;32(8):467-70. doi: 10.1002/clc.20603.

    PubMed 19685521
  • Kaw R, Hernandez AV, Masood I, Gillinov AM, Saliba W, Blackstone EH. Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2011 May;141(5):1305-12. doi: 10.1016/j.jtcvs.2010.10.040. Epub 2011 Jan 17.

    PubMed 21247589
  • Horwich P, Buth KJ, Legare JF. New onset postoperative atrial fibrillation is associated with a long-term risk for stroke and death following cardiac surgery. J Card Surg. 2013 Jan;28(1):8-13. doi: 10.1111/jocs.12033. Epub 2012 Nov 27.

    PubMed 23186205

Questions about this trial

What is this clinical trial studying?

An observational study of Atrial Fibrillation and Left Ventricular Diastolic Dysfunction, run by Helena DOMINGUEZ at 1 site in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 16 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Atrial fibrillation (time frame: before discharge within two weeks after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03962166, which also lists 40 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jan 2026.

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Clinical Trial NCT03962166 | AzTrials