Case-control Study on Atrial Electromechanical Coupling Time in Patients with New-onset Postoperative Atrial Fibrillation

Case-control Study on Atrial Electromechanical Coupling Time in Patients with New-onset Postoperative Atrial Fibrillation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Case-control Study on Atrial Electromechanical Coupling Time in Patients with New-onset Postoperative Atrial Fibrillation Yong Zhang, Fengjie Yue, Yan Jin, Fangran Xin, Yang Zhao, Yuji Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5660887/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Objective Atrial electromechanical coupling time (AEMCT) can be used to evaluate atrial electrical remodeling and early structural remodeling. This study explores the predictive role of AEMCT in postoperative new-onset AF (POAF) after off-pump isolated coronary artery bypass grafting (OPCAB). Methods Atotal of 116 patients who underwent OPCAB and left atrial diameter (LAD)<44mm were analyzed. According to 7-day continuous telemetry and Holter monitoring after OPCAB, the patients were divided into POAF group and non- POAF group. Results There was no significant difference in LAD between two group. Multivariate analysis found that P-A LA , T LA and HbA1c in POAF group were significantly higher than that in non-POAF group, that is, higher HbA1c, prolonged P-A LA and T LA were independent risk factors for POAF after OPCAB. P- A LA had the highest diagnostic predicting value. The AUC of HbA1c, P-A LA and T LA with Cut -off was 0.766, 95% CI: 0.67–0.86, P < 0.001. Conclusion In OPCAB patients without significant LAD enlargement, when P-A LA ≥ 96. 50 ms, there is more than 90% probability of POAF. The combination of HbA1c, P-A LA and T LA has the highest predictive value of POAF. AEMCT measured with TDI has the advantages of low cost and high repeatability. Health sciences/Cardiology Health sciences/Pathogenesis Health sciences/Signs and symptoms electrophysiology atrial electromechanical coupling time glycosylated hemoglobin postoperative new-onset atrial fibrillation off-pump coronary artery bypass grafting Figures Figure 1 Figure 2 Figure 3 Introduction New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery [ 1 – 3 ]. Among patients undergoing isolated coronary artery bypass grafting (CABG), the incidence of new-onset POAF is 20–40% [ 4 ], and this rate increases to 40–50% for patients undergoing valve surgery [ 5 ]. POAF increases the risk of congestive heart failure, embolic events and prolonged intensive care [ 6 – 9 ]. Patients without a history of atrial fibrillation (AF) develop new-onset POAF after coronary artery bypass grafting, and their risk of stroke and death is significantly increased [ 10 – 13 ]. POAF is the highest postoperative complication in cardiac surgery[ 4 ]. Therefore, the establishment of POAF prediction model can identify high-risk patients with AF before surgery and take preventive strategies, which is very important for improving the prognosis and life quality of CABG patients [ 14 , 15 ]. Left atrial size, P wave dispersion of ECG, left atrial wall strain [ 16 ] and Doppler velocity of left atrial appendage [ 17 ] are closely related to POAF. Atrial electromechanical coupling time (AEMCT) is the interval time between atrial electrical signal and atrial mechanical motion, which can be used to evaluate atrial electrical remodeling and early structural remodeling [ 18 ]. Early on, AEMCT was measured by invasive electrophysiological studies. To reduce invasive procedures and improve patient compliance, echocardiographic tissue Doppler imaging (TDI) was introduced to measure AEMCT [ 18 – 20 ]. TDI derived AEMCT has advantages in predicting POAF and AF recurrence [ 21 ]. This study explores the correlation between AEMCT and new-onset POAF in patients with off-pump coronary artery bypass grafting (OPCAB), and the predictive value of AEMCT for new-onset POAF. Results Analysis of Clinical Data (Table 1) All the data were collected before surgery, and data analysis was conducted on the results. The level of age and HbA1c, and the proportion of diabetes of POAF group were higher than those of non-POAF group, r < 0.05. There was no significant difference between the two groups in sex, hypertension, hyperlipidemia, smoking, drinking, classification of coronary artery stenosis, other blood biochemical indexes and preoperative medication, r > 0.05. Preoperative Ultrasound Data (Table 2) All the data were collected before surgery, and data analysis was conducted on the results. All the selected cases were patients with LAD 0.05. The Ei' and Ai' of POAF were significantly lower than those of non-POAF, r < 0.05. The comparison of Electromechanical Coupling Time of Two Groups of Patients was shown in Figure.1.A . The time of P-ALA and TLA of POAF were significantly prolonged than that of non-POAF, r < 0.05. There was no significant difference between POAF and non-POAF in LAD, Em/Am, LVEF, HR and PASP. Analysis of intraoperative and postoperative observation indicators There was no significant difference between the two groups in terms of operation duration, intraoperative blood loss, length of time in ICU, the use of IABP, postoperative infection rate, aspirin and low molecular weightheparin usage rate, and the number of bridging vessels, r > 0.05. Characteristics of New-onset POAF 37 patients (37/38, 97.4%) in POAF group had rapid AF (the fastest heart rate was more than 100 bpm). Only one patient developed slow AF (the fastest heart rate was less than 100 bpm). Characteristics of POAF were shown in Table 3. Multivariate Logistics Analysis (Table 4) Because of the interference between diabetes history and HbA1c in multivariate regression analysis, continuous variable HbA1c was selected for regression analysis. Since T LA is a component of P-A LA , these two factors were modeled and analyzed separately to avoid interference between them when included in multivariate analysis. Found that the HbA1c level in the POAF group was significantly higher than that in the non POAF group, and both models showed statistical significance. In their respective models, P-A LA and T LA in POAF group were significantly longer than those in non-POAF group. ROC Curve Analysis Diagnostic predicting value of P-A LA and T LA were shown in Figure.1.B. Among them, P-A LA had the highest diagnostic predicting value, and the AUC of P-A LA was 0.709, 95%CI: 0.60–0.82, P < 0.001(Cut-off = 96.50ms, Sensitivity = 42.10%, Specificity = 92.3%). The AUC of HbA1c was 0.668, 95%CI: 0.57–0.77, P = 0.003(Cut-off = 6.79%, Sensitivity = 47.40%, Specificity = 80.8%). The AUC of T LA was 0.693, 95%CI: 0.60–0.79, P = 0.001(Cut-off = 17.50ms, Sensitivity = 76.32%, Specificity = 59.0%). The AUC of P-A LA and T LA with Cut -off was 0.732, 95% CI: 0.63–0.84, P < 0.001. The combination of HbA1c, P-A LA , and T LA has the greatest value in predicting POAF. The AUC of HbA1c, P-A LA and T LA with Cut -off was 0.766, 95% CI: 0.67–0.86, P 0.05. P-ALA and TLA measured with special intelligent Doppler spectrum analysis software, and the intra- and inter-observer variability did not differ significantly, r > 0.05. Intra- and inter-observer agreement was well above 0.90 (r < 0.001) for all measures. Discussion Electrical remodeling, structural remodeling, electromechanical remodeling and autonomic nerve remodeling complement each other and are closely related to AF occurrence and development[ 22 – 24 ]. The most used method to evaluate the degree of atrial remodeling is to measure LA size, volume and strain, but these indicators have limited role in predicting the AF risk. The LA obvious enlargement indicates that LA structural remodeling has occurred, and patients with LA anteroposterior diameter > 44mm were more likely to develop AF[ 25 ]. This study focuses on OPCAB patients with no significant enlargement of the left atrium, in order to identify the risk factors for POAF in patients without significant structural remodeling. AEMCT is the time interval between the action potential generated by the excitation of atrial myocytes and the mechanical movement of atrial tissue [ 15 , 18 ]. The disordered anisotropic propagation of atrial electrical activity is manifested by the prolongation of AEMCT, which increases the risk of atrial arrhythmias. At present, research has found that patients with POAF already have ion channel abnormalities before surgery, namely electrical remodeling [26.27]. The abnormal transmission of electrical signals to mechanical activity, including local conduction delay and non-uniformity, known as electro-mechanical remodeling, is a key factor in the formation and maintenance of the atrial fibrillation return pathway. This study selected OPCAB patients with no significant LA enlargement as the study subjects, explored the correlation between AEMCT and new-onset POAF in OPCAB patients. P-A LA refers to the conduction time of the electrical signal P wave to the atrial motion at the annulus of the lateral wall of the mitral valve, and T LA refers to the electromechanical coupling conduction time (T) in the left atrium (TLA) was calculated, that is,T LA =(P-A LA )-(P-A IAS ). We found that AEMCT has predictive value for POAF in OPCAB patients, significant prolongation of P-A LA and T LA could be used as independent predictors of POAF after OPCAB. Since T LA is a component of P-A LA , these two factors were modeled and analyzed separately to avoid interference between them when included in multivariate analysis. We found that patients with significantly prolonged P-A LA are more likely to develop POAF. We also found that the increase of HbA1c is an independent risk factor for newly developed AF after OPCAB. This indicates that poor control of diabetes is an independent risk factor for POAF and the increase of HbA1c may be associated with atrial electrical remodeling. Electrical remodeling caused by diabetes has the characteristics of prolonged atrial conduction time, increased dispersion of atrial effective refractory period, and prolonged duration of action potential, which will increase the susceptibility to AF[ 28 ]. The combination of HbA1c, P-A LA , and T LA has the greatest value in predicting POAF. The AUC of HbA1c, P-A LA and T LA with Cut -off was 0.766, 95% CI: 0.67–0.86, P < 0.001. It shows that there is a strong association between the increase of HbA1c and the prolongation of P-A LA and T LA . The degree of increase in HbA1c can reflect the blood glucose control level of diabetes for three months. A significant increase in HbA1c indicates that the patient faces a heavier blood glucose load, which may cause more severe atrial electromechanical remodeling, which can be manifested as the prolongation of AEMCT. It is necessary to further explore the quantitative relationship between them and provide more support for clinical treatment. Diabetes can lead to atrial structural remodeling, electromechanical remodeling, autonomic neuropathy, endothelial dysfunction, inflammation, activation of renin angiotensin system, etc. [22.29.30]. Diabetes is independently related to myocardial fibrosis[ 31 , 32 ]. AEMCT of type 2 diabetes patients is longer than that of healthy people [ 33 ]. The changes of myocardial structure, oxidative stress and inflammation slow down the conduction between electrical and mechanical activities. The reduction of inflammation and oxidative stress in diabetes patients and the improvement of blood sugar can improve atrial remodeling, which is conducive to reducing the incidence of AF in diabetes patients[ 34 ]. Therefore, it is necessary to strengthen the blood glucose management of perioperative patients to reduce the occurrence of POAF. The atrium consists of overlapping cardiomyocytes, which gather in the form of myocardial fibers to form the atrial wall. Sinoatrial node is in the RA. When the current is generated, it propagates in a non-uniform and anisotropic way, depolarizing the RA and the LA successively. Compared with the RA, the arrangement of myocytes in the LA is relatively irregular from a histological point of view[ 35 ], and the current conduction in the left atrium is relatively more irregular. Electrical remodeling promotes the occurrence of AF by altering the expression and/or function of ion channel proteins. The longer AEMCT means the more uneven atrial transmission pulses, reflecting the degree of atrial remodeling[ 36 ], and is significantly related to the prolongation of the maximum P wave duration, the increase of P wave dispersion and histopathological changes. AEMCT can be used as one of the clinical indicators of early atrial remodeling. If the patient's AEMCT is found to be prolonged, it means that the patient has prolonged electromechanical conduction time of each wall of the atrium and increased conduction heterogeneity, which is prone to POAF. Therefore, it is necessary to strengthen personalized treatment for these patients in advance to avoid the occurrence of POAF. TDI imaging technology utilizing Doppler principle can measure the mechanical motion of myocardial segments and cardiac structures. The AEMCT measurement derived from this can be used as a non-invasive evaluation index for atrial conduction heterogeneity [37.38], and the electromechanical coupling time of the left atrial sidewall of the mitral annulus can be an important predictive indicator for identifying patients with paroxysmal AF [ 18 ]. We investigated risk factors for POAF in patients with OPCAB without significant left atrial enlargement and found that preoperative AEMCT of the left atrial wall at the lateral annulus of the mitral valve, namely P-A LA , could serve as an independent predictor of POAF after OPCAB.The measurement of AEMCT using echocardiography Doppler technology is a non-invasive method for predicting POAF and has clinical practicality.When P-A LA ≥ 96.50ms, the sensitivity and specificity of POAF after OPCAB were 42.10% and 92.30% respectively, and when T LA ≥ 17.50ms, the sensitivity and specificity of OPCAB were 76.30% and 59.00% respectively. Among them, P-ALA had stronger predictive value for POAF patients after OPCAB, AUC was 0.709, 95% CI was 0.60–0.82, r < 0.001. In univariate analysis of clinical data, we found that the newly diagnosed POAF in OPCAB patients was significantly correlated with age and diabetes (P = 0.010 and 0.017 respectively). In the multivariate analysis, we found that the increase of HbA1c is an independent risk factor for newly developed AF after OPCAB. In this group of cases, when HbA1c ≥ 6.79%, the sensitivity and specificity for diagnosing newly diagnosed AF after OPCAB were 47.40% and 80.80%, respectively. The reduction of inflammation and oxidative stress in diabetes patients and the improvement of blood sugar can improve atrial remodeling, which is conducive to reducing the incidence of AF in diabetes patients [ 34 ]. Therefore, it is necessary to strengthen the blood glucose management of perioperative patients to reduce the occurrence of POAF. Combining the results of HbA1c and AEMCT and performing effective preventive treatment may be one of the directions to treat POAF. Materials and Methods Study Design This is a case-control study. The protocol was approved by the Ethics Committee of the General Hospital of Northern Theater Command, No. Y (2020) 055, and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2200056127). Referring to our previous research [ 21 ], POAF was defined as any atrial tachyarrhythmia lasting longer than 30 seconds, detected by any of the following modalities: 12-lead ECG, continuous telemetry or 7-day Holter monitoring. (Shanghai Yueguang Medical Technology Co., Ltd., China). Study Population 116 patients receiving OPCAB from September 2020 to February 2021 were selected. Clinical data were collected for all consecutive patients, including preoperative medical history, complications, biochemical indicators, New York Heart Association (NYHA) functional classification, smoking and alcohol consumption, and coronary artery stenosis grade. Exclusion criteria: 1) previous AF or paroxysmal AF; 2) patients with moderate or severe mitral regurgitation caused by ischemia should be treated at the sametime; 3) left atrial anteroposterior diameter ≥ 44mm; 4) patients with significantly reduced left ventricular ejection fraction (LVEF) ≤ 0.40, Simpson’s biplane; 5) patients with preoperative thyroid insufficiency, electrolyte disorder and chronic obstructive pulmonary disease; 6) long-term Holter monitoring duration ≤ 5 days; 7) postoperative wound infection or pericardial infection; 8) patient-related data were missing or died after operation.The study flow chart is provided in Fig. 2 . Measurement All patients were examined by echocardiography with Philips iE33 and 5 − 1 MHz transducer within 2 days before operation. The measurement and calculation of cardiac ultrasound are recommended according to the guidelines of the American Society of Echocardiography[ 39 ]. The interval time from the starting point of P wave on ECG to the starting point of A´ wave on TDI spectrum was measured successively, and the P- A of atrium was obtained (As shown in Figure.3.A. Pulse-wave tissue Doppler imaging (PW-TDI) synchronously connected ECG was used to measure the early diastolic, late diastolic, and systolic peak velocities at the lateral wall of the mitral annulus (Em´, Am ´ and Sm´), the interatrial septal annulus (Ei´, Ai´ and Si´), and the lateral wall of the tricuspid annulus (Et´, At´ and St´) in the Four-chamber view (As shown in Figure.3.B). The AEMCT were measured at the left atrial lateral wall of the mitral annulus (P-ALA), the interatrial septal annulus (P-AIAS), the right atrial lateral wall of the tricuspid annulus (P-ARA), respectively. And, the electromechanical coupling conduction time (T) in the left atrium (TLA) and the right atrium (TRA) was calculated, that is,TLA=(P-ALA)-(P-AIAS), TRA=(P-AIAS)-(P-ARA). Two sonographers measured and averaged each Doppler spectrum image three times every other day in a single blind state. Surgery All operations were performed by the same cardiac anesthesiologist and surgical team. Endotracheal intubation with combined intravenous anesthesia, median sternotomy, off-pump coronary artery bypass grafting, the descending branch before internal mammary artery anastomosis and the great saphenous vein anastomosis with other vessels were preferred. Statistical Analysis Patients were divided into two groups according to whether new-onset POAF occurred, namely, POAF group (38, 32.7%) and non-POAF group (78, 67.3%). Quantitative variables, which were in the normal distribution, were reported as mean and standard deviation analyzed by T-test, or median and quartiles analyzed by Mann - Whitney U test, to compare the difference between groups. Qualitative variables were reported by number (proportion) and analyzed by Chi-square test or Fisher’s exact test between groups. Multivariate logistic regression was used to analyze the variables with r < 0.05. ROC curves were used to evaluate the predictive/classification performance ability of the significant statistical factors. All data were analyzed by SPSS 26. r < 0.05 was considered to be statistically significant. Declarations Competing interests The authors declare no competing financial interests. Author Contribution Fengjie Yue and Yan Jin wrote of the original draft. Fangran Xin designed the experiments. Yuji Zhang, Yang Zhao, Yong Zhang and Huishan Wang conducted the experiments. Yan Jin participated in conceptualization, methodology, manuscript review, and revision. All authors contributed to the article and approved the submitted version. Acknowledgement The authors thank Yachuan Pu and Yuji Zhang for assistance with analysis of Long Range Dynamic Electrocardiogram. Two anonymous reviewers provided helpful and constructive comments that improved the manuscript substantially. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Ahlsson, A. J., Bodin, L., Lundblad, O. H. & Englund, A. G. Postoperative atrial fibrillation is not correlated to C-reactive protein. Ann. Thorac. Surg. 83 , 1332–1337 (2007). Mathew, J. P. et al. A multicenter risk index for atrial fibrillation after cardiac surgery. Jama 291 , 1720–1729 (2004). Kongpakwattana, K., Dilokthornsakul, P., Dhippayom, T. & Chaiyakunapruk, N. Clinical and economic burden of postsurgical complications of high-risk surgeries: a cohort study in Thailand. J. Med. Econ. 23 , 1046–1052 (2020). Bessissow, A., Khan, J., Devereaux, P. J., Alvarez-Garcia, J. & Alonso-Coello, P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J. 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Tables Table.1 Clinical baseline data Variable Non-POAF(n=78) POAF(n=38) χ²/t P Female, n (%) 18(23.10) 9(23.70) 0.005 0.942 Age (Y) 61.54±7.87 65.42±6.66 -2.618 0.010 Hypertension, n (%) 47(60.30) 29(76.30) 2.917 0.088 Diabetes, n (%) 27(34.60) 22(57.90) 5.676 0.017 Smoking, n (%) 38(48.72) 23(60.52) 1.429 0.232 Drinking, n (%) 43(55.10) 20(52.60) 0.064 0.800 Left coronary stenosis Ⅳ, n (%) 18(23.10) 14(36.80) 2.242 0.120 Right coronary stenosis Ⅳ, n (%) 53(67.95) 28(73.68) 0.399 0.528 Metoprolol, n (%) 36(46.15) 17(44.74) 0.021 0.886 HbA1c, % 6.15±1.22 6.87±1.38 -2.900 0.004 NT-proBNP, pg/ml 956.97±34.45 972.12±56.79 1.781 0.078 Creatinine, μmol/L 94.46±24.67 85.83±56.23 1.151 0.252 NYHA functional classification 2.96 ± 0.51 3.17 ± 0.46 2.145 0.102 Table.2 Preoperative ultrasound data Variable Non -POAF (n=78) POAF (n=38) t P LAD(mm) 37.37±4.80 38.37±4.06 -1.102 0.273 LVIDd(mm) 46.97±5.38 47.16±5.64 -0.170 0.865 LVIDs(mm) 33.62±5.51 33.89±5.30 -0.260 0.796 Em(cm/s) 74.36±25.05 74.74±21.15 -0.080 0.936 Am(cm/s) 80.77±19.99 81.84±25.56 -0.247 0.805 Et(cm/s) 50.46±11.10 50.00±10.13 0.216 0.829 At(cm/s) 49.29±9.93 47.89±9.63 0.720 0.473 Em/Am 0.96±0.38 1.01±0.44 -0.555 0.580 Et/At 1.05±0.26 1.08±0.28 -0.554 0.581 Em´(cm/s) 7.62±1.90 7.05±1.64 1.561 0.121 Am´(cm/s) 10.32±2.47 9.47±2.51 2.917 0.088 Sm´(cm/s) 8.67±2.09 7.95±2.00 1.766 0.080 Ei´(cm/s) 5.73±1.38 5.11±1.29 2.336 0.021 Ai´(cm/s) 8.99±1.62 8.08±1.68 2.794 0.006 Si´(cm/s) 7.33±1.56 6.87±1.58 1.500 0.136 Et´(cm/s) 8.85±2.17 8.47±2.29 0.851 0.396 At´(cm/s) 13.85±2.38 13.87±2.79 -0.045 0.964 St´(cm/s) 12.08±2.44 11.95±2.20 0.277 0.782 LVEDV(ml) 106.13±27.95 108.26±29.38 -0.380 0.705 LVESV(ml) 48.28±20.69 49.50±19.24 -0.304 0.761 LVEF(%) 55.42±7.23 55.26±6.06 0.118 0.907 HR(times/min) 69.85±11.96 68.34±10.79 0.656 0.513 SPAP(mmHg) 36.92±7.23 37.58±7.08 -0.462 0.645 P-A LA (ms) 83.94±9.92 93.16±13.11 -4.216 ＜0.001 P-A IAS (ms) 65.42±8.73 69.05±11.01 -1.925 0.057 P-A RA (ms) 56.19±9.36 57.74±11.22 -0.733 0.466 T LA (ms) 18.51±9.30 24.11±8.95 -3.076 0.003 T RA (ms) 9.23±4.79 11.32±6.63 -1.731 0.089 P-A LA : the AEMCT at the left atrial lateral wall of the mitral annulus; P-A IAS : the AEMCT of the interatrial septal annulus; P-A RA : the AEMCT at the right atrial lateral wall of the tricuspid annulus; T LA : electromechanical coupling conduction time (T) in the LA; T RA : electromechanical coupling conduction time (T) in the RA. Table.3 Basic characteristics of AF in POAF group Characteristics minimum maximum P 25 P 50 P 75 Total Array Number(n) 1.00 2809.00 3.00 10.50 33.25 Atrial Fibrillation burden (min) 1.00 11472.00 70.25 392.00 1054.50 Total time ratio (%) 0.01 58.08 0.62 3.57 12.86 Fastest Heart Rate(times/min) 82.00 202.00 141.75 154.50 162.25 Maximum Duration(min) 1.00 8313.00 34.50 89.50 563.00 Longest RR(s) 0.70 8.80 1.00 1.30 1.50 Note: Atrial Fibrillation burden is defined as the sum of the duration of all AF episodes within 7 days after operation. Table.4 Multivariate logistics analysis Variable Multi-model of P-A LA Multi-model of T L A OR 95%CI P OR 95%CI P Age (Y) 1.056 0.99- 1.13 0.123 1.060 0.99- 1.13 0.084 HbA1c(%) 1.446 1.01-2.06 0.041 1.519 1.08-2.15 0.018 Ei´(cm/s) 0.891 0.60- 1.33 0.570 0.856 0.58- 1.27 0.439 Ai´(cm/s) 0.821 0.60- 1.12 0.215 0.826 0.61- 1.13 0.227 P-A LA (ms) 1.069 1.02- 1.12 0.004 - - T LA (ms) - - - 1.058 1.01- 1.11 0.018 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 07 Jul, 2025 Reviews received at journal 26 Jun, 2025 Reviews received at journal 18 Jun, 2025 Reviewers agreed at journal 11 Jun, 2025 Reviewers agreed at journal 09 Jun, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviewers invited by journal 14 Feb, 2025 Editor assigned by journal 10 Feb, 2025 Editor invited by journal 17 Jan, 2025 Submission checks completed at journal 16 Jan, 2025 First submitted to journal 17 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5660887","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":403544378,"identity":"28ca5805-d5f5-4acd-98f2-1634d504e0a6","order_by":0,"name":"Yong Zhang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Zhang","suffix":""},{"id":403544379,"identity":"a570d166-0249-45b8-9553-1837134e611f","order_by":1,"name":"Fengjie Yue","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Fengjie","middleName":"","lastName":"Yue","suffix":""},{"id":403544380,"identity":"7fe6fa16-bb1b-4eac-940e-f14a8ac9a170","order_by":2,"name":"Yan Jin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACNv72Awc+VNjI8csfbHyQUFFDWAufxJnEhzPOpBlLzmA+bPDgzDHCWuQYEoyNedsOJ264wZYm+bCFmQiHMRxIk+YB2TK7x6wisYGNgb+9OwG/FubGY5JzQH6ROWN2I3GHDIPEmbMbCNoi8QZkS0MOUMsZNgYDiVxCWhLMJMB+OZBjVpDYxkyUFmNDiPfT0hiI0wIP5J7DhyUSzhzjIegX+X5YVLI3Nn78UVEjx9/ei18LBuAhTfkoGAWjYBSMAqwAAO/1UTFy2/3hAAAAAElFTkSuQmCC","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Jin","suffix":""},{"id":403544381,"identity":"235f1f14-c3e4-4510-9935-78fa8f402663","order_by":3,"name":"Fangran Xin","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Fangran","middleName":"","lastName":"Xin","suffix":""},{"id":403544382,"identity":"526d7baf-cc44-4567-8451-7ae978c07c08","order_by":4,"name":"Yang Zhao","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Zhao","suffix":""},{"id":403544383,"identity":"1542f551-2228-41c5-92cd-426a766b909f","order_by":5,"name":"Yuji Zhang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yuji","middleName":"","lastName":"Zhang","suffix":""},{"id":403544384,"identity":"5bf4cc46-48af-4750-9a56-c494b0853e55","order_by":6,"name":"Huishan Wang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Huishan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-12-17 10:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5660887/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5660887/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-24316-w","type":"published","date":"2025-11-18T15:58:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":74285689,"identity":"90ef5195-6cc5-4a0c-8e76-31e8daef040b","added_by":"auto","created_at":"2025-01-20 16:14:26","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93718,"visible":true,"origin":"","legend":"\u003cp\u003eElectromechanical Coupling Time and Diagnostic predicting value of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e, T\u003csub\u003eLA\u003c/sub\u003e, and combining P-A\u003csub\u003eLA\u003c/sub\u003e, T\u003csub\u003eLA\u003c/sub\u003e\u0026nbsp;and/or HbA1c. A: Comparison between the new-onset POAF and Non-POAF patients; \u003cstrong\u003eB\u003c/strong\u003e: ROC analyses of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e, T\u003csub\u003eLA\u003c/sub\u003e, and combining P-A\u003csub\u003eLA\u003c/sub\u003e, T\u003csub\u003eLA\u003c/sub\u003e\u0026nbsp;and/or HbA1c\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5660887/v1/1b9f2b5b7161089dac3598c1.jpg"},{"id":74285458,"identity":"d7c40756-2b81-4e28-9f2e-1faeb83e54ba","added_by":"auto","created_at":"2025-01-20 16:14:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49985,"visible":true,"origin":"","legend":"\u003cp\u003eCase enrollment flow chart.\u003c/p\u003e\n\u003cp\u003eAF indicates atrial fibrillation; MR, mitral regurgitation; LAD, left atrial diameter; and LVEF, left ventricular ejection fraction.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5660887/v1/b4abe51454b13c95f3c2f2b7.jpg"},{"id":74285683,"identity":"63b720fc-564a-49f0-bb89-788c2d85c78f","added_by":"auto","created_at":"2025-01-20 16:14:24","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":68583,"visible":true,"origin":"","legend":"\u003cp\u003eBy measuring the interval from the start of the P wave in the electrocardiogram to the start of the A´ wave in the TDI spectrum, the electromechanical coupling time can be obtained (A). The three arrows from right to left respectively represent the positions of the lateral wall of the mitral annulus, the interatrial septal annulus, and the lateral wall of the tricuspid annulus in the Four-chamber view (B).\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5660887/v1/ee705e904b154cadf93bdec8.jpg"},{"id":96650215,"identity":"2e8c3351-3a3c-46ad-925d-12b1395711a1","added_by":"auto","created_at":"2025-11-24 16:09:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":912163,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5660887/v1/6aa0325f-bde1-4539-a63e-3b6ade3dfa49.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case-control Study on Atrial Electromechanical Coupling Time in Patients with New-onset Postoperative Atrial Fibrillation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNew-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among patients undergoing isolated coronary artery bypass grafting (CABG), the incidence of new-onset POAF is 20\u0026ndash;40% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and this rate increases to 40\u0026ndash;50% for patients undergoing valve surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. POAF increases the risk of congestive heart failure, embolic events and prolonged intensive care [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Patients without a history of atrial fibrillation (AF) develop new-onset POAF after coronary artery bypass grafting, and their risk of stroke and death is significantly increased [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. POAF is the highest postoperative complication in cardiac surgery[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, the establishment of POAF prediction model can identify high-risk patients with AF before surgery and take preventive strategies, which is very important for improving the prognosis and life quality of CABG patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeft atrial size, P wave dispersion of ECG, left atrial wall strain [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Doppler velocity of left atrial appendage [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] are closely related to POAF. Atrial electromechanical coupling time (AEMCT) is the interval time between atrial electrical signal and atrial mechanical motion, which can be used to evaluate atrial electrical remodeling and early structural remodeling [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Early on, AEMCT was measured by invasive electrophysiological studies. To reduce invasive procedures and improve patient compliance, echocardiographic tissue Doppler imaging (TDI) was introduced to measure AEMCT [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. TDI derived AEMCT has advantages in predicting POAF and AF recurrence [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This study explores the correlation between AEMCT and new-onset POAF in patients with off-pump coronary artery bypass grafting (OPCAB), and the predictive value of AEMCT for new-onset POAF.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAnalysis of Clinical Data (Table\u0026nbsp;1)\u003c/p\u003e \u003cp\u003eAll the data were collected before surgery, and data analysis was conducted on the results.\u003c/p\u003e \u003cp\u003eThe level of age and HbA1c, and the proportion of diabetes of POAF group were higher than those of non-POAF group, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. There was no significant difference between the two groups in sex, hypertension, hyperlipidemia, smoking, drinking, classification of coronary artery stenosis, other blood biochemical indexes and preoperative medication, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003ePreoperative Ultrasound Data (Table\u0026nbsp;2)\u003c/p\u003e \u003cp\u003eAll the data were collected before surgery, and data analysis was conducted on the results.\u003c/p\u003e \u003cp\u003eAll the selected cases were patients with LAD\u0026thinsp;\u0026lt;\u0026thinsp;44mm, and there was no significant difference in LAD between POAF group and non-POAF group, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05. The Ei' and Ai' of POAF were significantly lower than those of non-POAF, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The comparison of Electromechanical Coupling Time of Two Groups of Patients was shown in \u003cb\u003eFigure.1.A\u003c/b\u003e. The time of P-ALA and TLA of POAF were significantly prolonged than that of non-POAF, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. There was no significant difference between POAF and non-POAF in LAD, Em/Am, LVEF, HR and PASP.\u003c/p\u003e \u003cp\u003eAnalysis of intraoperative and postoperative observation indicators\u003c/p\u003e \u003cp\u003eThere was no significant difference between the two groups in terms of operation duration, intraoperative blood loss, length of time in ICU, the use of IABP, postoperative infection rate, aspirin and low molecular weightheparin usage rate, and the number of bridging vessels, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eCharacteristics of New-onset POAF\u003c/p\u003e \u003cp\u003e37 patients (37/38, 97.4%) in POAF group had rapid AF (the fastest heart rate was more than 100 bpm). Only one patient developed slow AF (the fastest heart rate was less than 100 bpm). Characteristics of POAF were shown in Table\u0026nbsp;3.\u003c/p\u003e \u003cp\u003eMultivariate Logistics Analysis (Table\u0026nbsp;4)\u003c/p\u003e \u003cp\u003eBecause of the interference between diabetes history and HbA1c in multivariate regression analysis, continuous variable HbA1c was selected for regression analysis. Since T\u003csub\u003eLA\u003c/sub\u003e is a component of P-A\u003csub\u003eLA\u003c/sub\u003e, these two factors were modeled and analyzed separately to avoid interference between them when included in multivariate analysis. Found that the HbA1c level in the POAF group was significantly higher than that in the non POAF group, and both models showed statistical significance. In their respective models, P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e in POAF group were significantly longer than those in non-POAF group.\u003c/p\u003e \u003cp\u003eROC Curve Analysis\u003c/p\u003e \u003cp\u003eDiagnostic predicting value of P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e were shown in Figure.1.B. Among them, P-A\u003csub\u003eLA\u003c/sub\u003e had the highest diagnostic predicting value, and the AUC of P-A\u003csub\u003eLA\u003c/sub\u003e was 0.709, 95%CI: 0.60\u0026ndash;0.82, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001(Cut-off =\u0026thinsp;96.50ms, Sensitivity\u0026thinsp;=\u0026thinsp;42.10%, Specificity\u0026thinsp;=\u0026thinsp;92.3%). The AUC of HbA1c was 0.668, 95%CI: 0.57\u0026ndash;0.77, P\u0026thinsp;=\u0026thinsp;0.003(Cut-off =\u0026thinsp;6.79%, Sensitivity\u0026thinsp;=\u0026thinsp;47.40%, Specificity\u0026thinsp;=\u0026thinsp;80.8%). The AUC of T\u003csub\u003eLA\u003c/sub\u003e was 0.693, 95%CI: 0.60\u0026ndash;0.79, P\u0026thinsp;=\u0026thinsp;0.001(Cut-off =\u0026thinsp;17.50ms, Sensitivity\u0026thinsp;=\u0026thinsp;76.32%, Specificity\u0026thinsp;=\u0026thinsp;59.0%). The AUC of P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e with Cut -off was 0.732, 95% CI: 0.63\u0026ndash;0.84, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The combination of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e, and T\u003csub\u003eLA\u003c/sub\u003e has the greatest value in predicting POAF. The AUC of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e with Cut -off was 0.766, 95% CI: 0.67\u0026ndash;0.86, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cp\u003eInter- and intra-observer variability of analysis\u003c/p\u003e \u003cp\u003eIntra- and inter-observer variability did not differ significantly in measuring\u003c/p\u003e \u003cp\u003eUltrasound Data, r\u0026thinsp;\u0026gt;\u0026thinsp;0.05. P-ALA and TLA measured with special intelligent Doppler spectrum analysis software, and the intra- and inter-observer variability did not differ significantly, r\u0026thinsp;\u0026gt;\u0026thinsp;0.05. Intra- and inter-observer agreement was well above 0.90 (r\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for all measures.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eElectrical remodeling, structural remodeling, electromechanical remodeling and autonomic nerve remodeling complement each other and are closely related to AF occurrence and development[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The most used method to evaluate the degree of atrial remodeling is to measure LA size, volume and strain, but these indicators have limited role in predicting the AF risk. The LA obvious enlargement indicates that LA structural remodeling has occurred, and patients with LA anteroposterior diameter\u0026thinsp;\u0026gt;\u0026thinsp;44mm were more likely to develop AF[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study focuses on OPCAB patients with no significant enlargement of the left atrium, in order to identify the risk factors for POAF in patients without significant structural remodeling.\u003c/p\u003e \u003cp\u003eAEMCT is the time interval between the action potential generated by the excitation of atrial myocytes and the mechanical movement of atrial tissue [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The disordered anisotropic propagation of atrial electrical activity is manifested by the prolongation of AEMCT, which increases the risk of atrial arrhythmias. At present, research has found that patients with POAF already have ion channel abnormalities before surgery, namely electrical remodeling [26.27]. The abnormal transmission of electrical signals to mechanical activity, including local conduction delay and non-uniformity, known as electro-mechanical remodeling, is a key factor in the formation and maintenance of the atrial fibrillation return pathway. This study selected OPCAB patients with no significant LA enlargement as the study subjects, explored the correlation between AEMCT and new-onset POAF in OPCAB patients.\u003c/p\u003e \u003cp\u003eP-A\u003csub\u003eLA\u003c/sub\u003e refers to the conduction time of the electrical signal P wave to the atrial motion at the annulus of the lateral wall of the mitral valve, and T\u003csub\u003eLA\u003c/sub\u003e refers to the electromechanical coupling conduction time (T) in the left atrium (TLA) was calculated, that is,T\u003csub\u003eLA\u003c/sub\u003e=(P-A\u003csub\u003eLA\u003c/sub\u003e)-(P-A\u003csub\u003eIAS\u003c/sub\u003e). We found that AEMCT has predictive value for POAF in OPCAB patients, significant prolongation of P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e could be used as independent predictors of POAF after OPCAB. Since T\u003csub\u003eLA\u003c/sub\u003e is a component of P-A\u003csub\u003eLA\u003c/sub\u003e, these two factors were modeled and analyzed separately to avoid interference between them when included in multivariate analysis. We found that patients with significantly prolonged P-A\u003csub\u003eLA\u003c/sub\u003e are more likely to develop POAF.\u003c/p\u003e \u003cp\u003eWe also found that the increase of HbA1c is an independent risk factor for newly developed AF after OPCAB. This indicates that poor control of diabetes is an independent risk factor for POAF and the increase of HbA1c may be associated with atrial electrical remodeling. Electrical remodeling caused by diabetes has the characteristics of prolonged atrial conduction time, increased dispersion of atrial effective refractory period, and prolonged duration of action potential, which will increase the susceptibility to AF[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The combination of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e, and T\u003csub\u003eLA\u003c/sub\u003e has the greatest value in predicting POAF. The AUC of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e with Cut -off was 0.766, 95% CI: 0.67\u0026ndash;0.86, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. It shows that there is a strong association between the increase of HbA1c and the prolongation of P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e. The degree of increase in HbA1c can reflect the blood glucose control level of diabetes for three months. A significant increase in HbA1c indicates that the patient faces a heavier blood glucose load, which may cause more severe atrial electromechanical remodeling, which can be manifested as the prolongation of AEMCT. It is necessary to further explore the quantitative relationship between them and provide more support for clinical treatment.\u003c/p\u003e \u003cp\u003eDiabetes can lead to atrial structural remodeling, electromechanical remodeling, autonomic neuropathy, endothelial dysfunction, inflammation, activation of renin angiotensin system, etc. [22.29.30]. Diabetes is independently related to myocardial fibrosis[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. AEMCT of type 2 diabetes patients is longer than that of healthy people [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The changes of myocardial structure, oxidative stress and inflammation slow down the conduction between electrical and mechanical activities. The reduction of inflammation and oxidative stress in diabetes patients and the improvement of blood sugar can improve atrial remodeling, which is conducive to reducing the incidence of AF in diabetes patients[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, it is necessary to strengthen the blood glucose management of perioperative patients to reduce the occurrence of POAF.\u003c/p\u003e \u003cp\u003eThe atrium consists of overlapping cardiomyocytes, which gather in the form of myocardial fibers to form the atrial wall. Sinoatrial node is in the RA. When the current is generated, it propagates in a non-uniform and anisotropic way, depolarizing the RA and the LA successively. Compared with the RA, the arrangement of myocytes in the LA is relatively irregular from a histological point of view[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and the current conduction in the left atrium is relatively more irregular. Electrical remodeling promotes the occurrence of AF by altering the expression and/or function of ion channel proteins. The longer AEMCT means the more uneven atrial transmission pulses, reflecting the degree of atrial remodeling[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and is significantly related to the prolongation of the maximum P wave duration, the increase of P wave dispersion and histopathological changes. AEMCT can be used as one of the clinical indicators of early atrial remodeling. If the patient's AEMCT is found to be prolonged, it means that the patient has prolonged electromechanical conduction time of each wall of the atrium and increased conduction heterogeneity, which is prone to POAF. Therefore, it is necessary to strengthen personalized treatment for these patients in advance to avoid the occurrence of POAF.\u003c/p\u003e \u003cp\u003eTDI imaging technology utilizing Doppler principle can measure the mechanical motion of myocardial segments and cardiac structures. The AEMCT measurement derived from this can be used as a non-invasive evaluation index for atrial conduction heterogeneity [37.38], and the electromechanical coupling time of the left atrial sidewall of the mitral annulus can be an important predictive indicator for identifying patients with paroxysmal AF [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. We investigated risk factors for POAF in patients with OPCAB without significant left atrial enlargement and found that preoperative AEMCT of the left atrial wall at the lateral annulus of the mitral valve, namely P-A\u003csub\u003eLA\u003c/sub\u003e, could serve as an independent predictor of POAF after OPCAB.The measurement of AEMCT using echocardiography Doppler technology is a non-invasive method for predicting POAF and has clinical practicality.When P-A\u003csub\u003eLA\u003c/sub\u003e \u0026ge; 96.50ms, the sensitivity and specificity of POAF after OPCAB were 42.10% and 92.30% respectively, and when T\u003csub\u003eLA\u003c/sub\u003e \u0026ge; 17.50ms, the sensitivity and specificity of OPCAB were 76.30% and 59.00% respectively. Among them, P-ALA had stronger predictive value for POAF patients after OPCAB, AUC was 0.709, 95% CI was 0.60\u0026ndash;0.82, r\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cp\u003eIn univariate analysis of clinical data, we found that the newly diagnosed POAF in OPCAB patients was significantly correlated with age and diabetes (P\u0026thinsp;=\u0026thinsp;0.010 and 0.017 respectively). In the multivariate analysis, we found that the increase of HbA1c is an independent risk factor for newly developed AF after OPCAB. In this group of cases, when HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;6.79%, the sensitivity and specificity for diagnosing newly diagnosed AF after OPCAB were 47.40% and 80.80%, respectively. The reduction of inflammation and oxidative stress in diabetes patients and the improvement of blood sugar can improve atrial remodeling, which is conducive to reducing the incidence of AF in diabetes patients [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, it is necessary to strengthen the blood glucose management of perioperative patients to reduce the occurrence of POAF. Combining the results of HbA1c and AEMCT and performing effective preventive treatment may be one of the directions to treat POAF.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis is a case-control study. The protocol was approved by the Ethics Committee of the General Hospital of Northern Theater Command, No. Y (2020) 055, and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2200056127). Referring to our previous research [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], POAF was defined as any atrial tachyarrhythmia lasting longer than 30 seconds, detected by any of the following modalities: 12-lead ECG, continuous telemetry or 7-day Holter monitoring. (Shanghai Yueguang Medical Technology Co., Ltd., China).\u003c/p\u003e \u003cp\u003eStudy Population\u003c/p\u003e \u003cp\u003e116 patients receiving OPCAB from September 2020 to February 2021 were selected. Clinical data were collected for all consecutive patients, including preoperative medical history, complications, biochemical indicators, New York Heart Association (NYHA) functional classification, smoking and alcohol consumption, and coronary artery stenosis grade. Exclusion criteria: 1) previous AF or paroxysmal AF; 2) patients with moderate or severe mitral regurgitation caused by ischemia should be treated at the sametime; 3) left atrial anteroposterior diameter\u0026thinsp;\u0026ge;\u0026thinsp;44mm; 4) patients with significantly reduced left ventricular ejection fraction (LVEF)\u0026thinsp;\u0026le;\u0026thinsp;0.40, Simpson\u0026rsquo;s biplane; 5) patients with preoperative thyroid insufficiency, electrolyte disorder and chronic obstructive pulmonary disease; 6) long-term Holter monitoring duration\u0026thinsp;\u0026le;\u0026thinsp;5 days; 7) postoperative wound infection or pericardial infection; 8) patient-related data were missing or died after operation.The study flow chart is provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eMeasurement\u003c/p\u003e \u003cp\u003eAll patients were examined by echocardiography with Philips iE33 and 5\u0026thinsp;\u0026minus;\u0026thinsp;1 MHz transducer within 2 days before operation. The measurement and calculation of cardiac ultrasound are recommended according to the guidelines of the American Society of Echocardiography[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The interval time from the starting point of P wave on ECG to the starting point of A\u0026acute; wave on TDI spectrum was measured successively, and the P- A of atrium was obtained (As shown in Figure.3.A. Pulse-wave tissue Doppler imaging (PW-TDI) synchronously connected ECG was used to measure the early diastolic, late diastolic, and systolic peak velocities at the lateral wall of the mitral annulus (Em\u0026acute;, Am \u0026acute; and Sm\u0026acute;), the interatrial septal annulus (Ei\u0026acute;, Ai\u0026acute; and Si\u0026acute;), and the lateral wall of the tricuspid annulus (Et\u0026acute;, At\u0026acute; and St\u0026acute;) in the Four-chamber view (As shown in Figure.3.B). The AEMCT were measured at the left atrial lateral wall of the mitral annulus (P-ALA), the interatrial septal annulus (P-AIAS), the right atrial lateral wall of the tricuspid annulus (P-ARA), respectively. And, the electromechanical coupling conduction time (T) in the left atrium (TLA) and the right atrium (TRA) was calculated, that is,TLA=(P-ALA)-(P-AIAS), TRA=(P-AIAS)-(P-ARA). Two sonographers measured and averaged each Doppler spectrum image three times every other day in a single blind state.\u003c/p\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003cp\u003eAll operations were performed by the same cardiac anesthesiologist and surgical team. Endotracheal intubation with combined intravenous anesthesia, median sternotomy, off-pump coronary artery bypass grafting, the descending branch before internal mammary artery anastomosis and the great saphenous vein anastomosis with other vessels were preferred.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003ePatients were divided into two groups according to whether new-onset POAF occurred, namely, POAF group (38, 32.7%) and non-POAF group (78, 67.3%). Quantitative variables, which were in the normal distribution, were reported as mean and standard deviation analyzed by T-test, or median and quartiles analyzed by Mann - Whitney U test, to compare the difference between groups. Qualitative variables were reported by number (proportion) and analyzed by Chi-square test or Fisher\u0026rsquo;s exact test between groups. Multivariate logistic regression was used to analyze the variables with \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. ROC curves were used to evaluate the predictive/classification performance ability of the significant statistical factors. All data were analyzed by SPSS 26. \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing financial interests.\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFengjie Yue and Yan Jin wrote of the original draft. Fangran Xin designed the experiments. Yuji Zhang, Yang Zhao, Yong Zhang and Huishan Wang conducted the experiments. Yan Jin participated in conceptualization, methodology, manuscript review, and revision. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank Yachuan Pu and Yuji Zhang for assistance with analysis of Long Range Dynamic Electrocardiogram. Two anonymous reviewers provided helpful and constructive comments that improved the manuscript substantially.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhlsson, A. J., Bodin, L., Lundblad, O. H. \u0026amp; Englund, A. G. Postoperative atrial fibrillation is not correlated to C-reactive protein. \u003cem\u003eAnn. Thorac. Surg.\u003c/em\u003e \u003cb\u003e83\u003c/b\u003e, 1332\u0026ndash;1337 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathew, J. 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Atrial fibrillation pattern, left atrial diameter and risk of cardiovascular events and mortality. A prospective multicenter cohort study. \u003cem\u003eInt. J. Clin. Pract.\u003c/em\u003e \u003cb\u003e75\u003c/b\u003e, e13771 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeijman, J. et al. Atrial Myocyte NLRP3/CaMKII Nexus Forms a Substrate for Postoperative Atrial Fibrillation. \u003cem\u003eCirc. Res.\u003c/em\u003e \u003cb\u003e127\u003c/b\u003e (8), 1036\u0026ndash;1055 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Schie, M. S. et al. Characterization of pre-existing arrhythmogenic substrate associated with de novo early and late postoperative atrial fibrillation. \u003cem\u003eInt. J. Cardiol.\u003c/em\u003e \u003cb\u003e363\u003c/b\u003e, 71\u0026ndash;79 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatanabe, M. et al. Conduction and refractory disorders in the diabetic atrium. \u003cem\u003eAm. J. Physiol. Heart Circ. Physiol.\u003c/em\u003e \u003cb\u003e303\u003c/b\u003e, H86\u0026ndash;95 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoudis, C. A. et al. Diabetes mellitus and atrial fibrillation: Pathophysiological mechanisms and potential upstream therapies. \u003cem\u003eInt. J. Cardiol.\u003c/em\u003e \u003cb\u003e184\u003c/b\u003e, 617\u0026ndash;622 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePr\u0026iacute;davkov\u0026aacute;, D. et al. Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation, Journal of diabetes research, (2019) 5158308. (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRusso, I. \u0026amp; Frangogiannis, N. G. Diabetes-associated cardiac fibrosis: Cellular effectors, molecular mechanisms and therapeutic opportunities. \u003cem\u003eJ. Mol. Cell. Cardiol.\u003c/em\u003e \u003cb\u003e90\u003c/b\u003e, 84\u0026ndash;93 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGranger, C. B. \u0026amp; Mahaffey, K. W. Preventing Atrial Fibrillation With Treatments for Diabetes Mellitus, Circulation, 141 1235\u0026ndash;1237. (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemir, K. et al. Assessment of atrial electromechanical delay and P-wave dispersion inpatients with type 2 diabetes mellitus. \u003cem\u003eJ. Cardiol.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e, 378\u0026ndash;383 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZelniker, T. A. et al. Effect of Dapagliflozin on Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus: Insights From the DECLARE- TIMI 58 Trial, Circulation, 141 1227\u0026ndash;1234. (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHari, K. J., Nguyen, T. P. \u0026amp; Soliman, E. Z. Relationship between P-wave duration and the risk of atrial fibrillation. \u003cem\u003eExpert Rev. Cardiovasc. Ther.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e, 837\u0026ndash;843 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaff\u0026egrave;, S. et al. U. Parravici ni, Prognostic value of total atrial conduction time measured with tissue Doppler imaging to predict the maintenance of sinus rhythm after external electrical cardioversion of persistent atrial fibrillation, Echocardiography (2015). (Mount Kisco, N.Y.), \u003cb\u003e32\u003c/b\u003e 420\u0026ndash;427 .\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRago, A. et al. The role of the atrial electromechanical delay in predicting atrial fibrillation in beta- thalassemia major patients. \u003cem\u003eJ. interventional cardiac electrophysiology: Int. J. Arrhythm. pacing\u003c/em\u003e. \u003cb\u003e48\u003c/b\u003e, 147\u0026ndash;157 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeniz, A. et al. Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time. \u003cem\u003eCardiol. J.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e, 487\u0026ndash;493 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishimura, R. A. \u0026amp; Carabello, B. Operationalizing the 2014 ACC/AHA Guidelines for Valvular Heart Disease: A Guide for Clinicians. \u003cem\u003eJ. Am. Coll. Cardiol.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e, 2289\u0026ndash;2294 (2016).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable.1 Clinical baseline data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"608\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003eNon-POAF(n=78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003ePOAF(n=38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u0026sup2;/t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e18(23.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e9(23.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eAge (Y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e61.54\u0026plusmn;7.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e65.42\u0026plusmn;6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e-2.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eHypertension, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e47(60.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e29(76.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e2.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eDiabetes, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e27(34.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e22(57.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e5.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e38(48.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e23(60.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e1.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eDrinking, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e43(55.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e20(52.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eLeft coronary stenosis Ⅳ, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e18(23.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e14(36.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e2.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eRight coronary stenosis Ⅳ, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e53(67.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e28(73.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eMetoprolol, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e36(46.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e17(44.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eHbA1c, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e6.15\u0026plusmn;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e6.87\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e-2.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eNT-proBNP, pg/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e956.97\u0026plusmn;34.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e972.12\u0026plusmn;56.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e1.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eCreatinine, \u0026mu;mol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e94.46\u0026plusmn;24.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e85.83\u0026plusmn;56.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e1.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6908%;\"\u003e\n \u003cp\u003eNYHA functional\u0026nbsp;classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.5329%;\"\u003e\n \u003cp\u003e2.96\u0026nbsp;\u0026plusmn;\u0026nbsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7368%;\"\u003e\n \u003cp\u003e3.17\u0026nbsp;\u0026plusmn;\u0026nbsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86842%;\"\u003e\n \u003cp\u003e2.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1711%;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable.2 Preoperative ultrasound data\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"464\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003eNon -POAF (n=78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003ePOAF (n=38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eLAD(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e37.37\u0026plusmn;4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e38.37\u0026plusmn;4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-1.102\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eLVIDd(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e46.97\u0026plusmn;5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e47.16\u0026plusmn;5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-0.170\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eLVIDs(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e33.62\u0026plusmn;5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e33.89\u0026plusmn;5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-0.260\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n 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14.4708%;\"\u003e\n \u003cp\u003e0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eEt(cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e50.46\u0026plusmn;11.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e50.00\u0026plusmn;10.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e0.216\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eAt(cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e49.29\u0026plusmn;9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e47.89\u0026plusmn;9.63\u003c/p\u003e\n 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style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eSt\u0026acute;(cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e12.08\u0026plusmn;2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e11.95\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e0.277\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eLVEDV(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e106.13\u0026plusmn;27.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n 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style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e55.42\u0026plusmn;7.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e55.26\u0026plusmn;6.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e0.118\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eHR(times/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e69.85\u0026plusmn;11.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e68.34\u0026plusmn;10.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e0.656\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eSPAP(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e36.92\u0026plusmn;7.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e37.58\u0026plusmn;7.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-0.462\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eP-A\u003csub\u003eLA\u003c/sub\u003e (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e83.94\u0026plusmn;9.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e93.16\u0026plusmn;13.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-4.216\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eP-A\u003csub\u003eIAS\u003c/sub\u003e (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e65.42\u0026plusmn;8.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e69.05\u0026plusmn;11.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-1.925\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eP-A\u003csub\u003eRA\u003c/sub\u003e (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e56.19\u0026plusmn;9.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e57.74\u0026plusmn;11.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-0.733\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eT\u003csub\u003eLA\u003c/sub\u003e (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e18.51\u0026plusmn;9.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e24.11\u0026plusmn;8.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-3.076\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2462%;\"\u003e\n \u003cp\u003eT\u003csub\u003eRA\u003c/sub\u003e (ms) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.2937%;\"\u003e\n \u003cp\u003e9.23\u0026plusmn;4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e11.32\u0026plusmn;6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.2549%;\"\u003e\n \u003cp\u003e-1.731\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4708%;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP-A\u003csub\u003eLA\u003c/sub\u003e: the AEMCT at the left atrial lateral wall of the mitral annulus; P-A\u003csub\u003eIAS\u003c/sub\u003e: the AEMCT of the interatrial septal annulus; P-A\u003csub\u003eRA\u003c/sub\u003e: the AEMCT at the right atrial lateral wall of the tricuspid annulus; T\u003csub\u003eLA\u003c/sub\u003e: \u0026nbsp;electromechanical coupling conduction time (T) in the LA; T\u003csub\u003eRA\u003c/sub\u003e:\u0026nbsp;electromechanical coupling conduction time (T) in the RA.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable.3 Basic characteristics of\u0026nbsp;AF\u0026nbsp;in POAF group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003eminimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003emaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003eP\u003csub\u003e25\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003eP\u003csub\u003e50\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003eP\u003csub\u003e75\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eTotal Array Number(n)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e2809.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e10.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e33.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eAtrial Fibrillation burden (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e11472.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e70.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e392.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e1054.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eTotal time ratio (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e58.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e12.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eFastest Heart Rate(times/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e82.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e202.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e141.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e154.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e162.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eMaximum Duration(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e8313.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e34.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e89.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e563.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8141%;\"\u003e\n \u003cp\u003eLongest RR(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5064%;\"\u003e\n \u003cp\u003e8.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2564%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7372%;\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3397%;\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Atrial Fibrillation burden is defined as the sum of the duration of all AF episodes within 7 days after operation.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable.4 Multivariate logistics analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 40px;\"\u003e\n \u003cp\u003eMulti-model\u0026nbsp;of\u0026nbsp;P-A\u003csub\u003eLA\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 42px;\"\u003e\n \u003cp\u003eMulti-model\u0026nbsp;of\u0026nbsp;T\u003csub\u003eL\u003c/sub\u003e\u003csub\u003eA\u003c/sub\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;(Y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.99-\u0026nbsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.99- 1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eHbA1c(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.01-2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.08-2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eEi\u0026acute;(cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.60-\u0026nbsp;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.58- 1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eAi\u0026acute;(cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.60-\u0026nbsp;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 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\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"electrophysiology, atrial electromechanical coupling time, glycosylated hemoglobin, postoperative new-onset atrial fibrillation, off-pump coronary artery bypass grafting","lastPublishedDoi":"10.21203/rs.3.rs-5660887/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5660887/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eAtrial electromechanical coupling time (AEMCT) can be used to evaluate atrial electrical remodeling and early structural remodeling. This study explores the predictive role of AEMCT in postoperative new-onset AF (POAF) after off-pump isolated coronary artery bypass grafting (OPCAB).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAtotal of 116 patients who underwent OPCAB and left atrial diameter (LAD)\u0026lt;44mm were analyzed. According to 7-day continuous telemetry and Holter monitoring after OPCAB, the patients were divided into POAF group and non- POAF group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no significant difference in LAD between two group. Multivariate analysis found that P-A\u003csub\u003eLA\u003c/sub\u003e, T\u003csub\u003eLA\u003c/sub\u003e and HbA1c in POAF group were significantly higher than that in non-POAF group, that is, higher HbA1c, prolonged P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e were independent risk factors for POAF after OPCAB. P- A\u003csub\u003eLA\u003c/sub\u003e had the highest diagnostic predicting value. The AUC of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e with Cut -off was 0.766, 95% CI: 0.67\u0026ndash;0.86, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn OPCAB patients without significant LAD enlargement, when P-A\u003csub\u003eLA\u003c/sub\u003e \u0026ge; 96. 50 ms, there is more than 90% probability of POAF. The combination of HbA1c, P-A\u003csub\u003eLA\u003c/sub\u003e and T\u003csub\u003eLA\u003c/sub\u003e has the highest predictive value of POAF. AEMCT measured with TDI has the advantages of low cost and high repeatability.\u003c/p\u003e","manuscriptTitle":"Case-control Study on Atrial Electromechanical Coupling Time in Patients with New-onset Postoperative Atrial Fibrillation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-20 16:01:13","doi":"10.21203/rs.3.rs-5660887/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-07T06:13:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T05:36:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T21:45:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199570480206535810370132298944659901373","date":"2025-06-12T00:17:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109235317451747282316396868156924924448","date":"2025-06-09T06:18:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164738644893327565835597190372687030445","date":"2025-02-17T09:38:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-14T08:35:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-10T17:12:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-17T13:14:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-16T11:31:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-12-17T10:24:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6a4940a-0f97-438f-846a-5683ff6e27df","owner":[],"postedDate":"January 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":43026912,"name":"Health sciences/Cardiology"},{"id":43026913,"name":"Health sciences/Pathogenesis"},{"id":43026914,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2025-11-24T16:04:08+00:00","versionOfRecord":{"articleIdentity":"rs-5660887","link":"https://doi.org/10.1038/s41598-025-24316-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-11-18 15:58:44","publishedOnDateReadable":"November 18th, 2025"},"versionCreatedAt":"2025-01-20 16:01:13","video":"","vorDoi":"10.1038/s41598-025-24316-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-24316-w","workflowStages":[]},"version":"v1","identity":"rs-5660887","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5660887","identity":"rs-5660887","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}