Postoperative atrial fibrillation after thoracic surgery (PoAF): risk factors and outcome

CARDIOTHORACIC SURGEON
Valentina Scheggi1, Silvia Menale2, Rossella Marcucci3, Anna Dematté1, Jacopo Giovacchini2, Noemi Cenni2, Giorgio Vitale4, Bruno Alterini1, Alberto Salvicchi5, Matteo Tamburini1, Simona Musmeci1, Stefano Bongiolatti5, Luca Voltolini6, Niccolò Marchionni3
1Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
2Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
3Division of General Cardiology, Cardiothoracovascular Department, Department of Experimental and Clinical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
4Division of Pneumology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
5Division of Thoracic Surgery, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
6Division of Thoracic Surgery, Cardiothoracovascular Department, Department of Experimental and Clinical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy

Tóm tắt

Abstract Background Postoperative AF (PoAF) is a common complication of the early postoperative period of noncardiac, thoracic surgery and is associated with prolonged hospital stay. In order to investigate the predictors of PoAF in the specific setting of lung surgery of oncologic patients, we retrospectively analyzed 338 consecutive patients admitted to our department to be operated for lung cancer with a thoracotomy approach (i.e., open surgery). We determined this population’s prevalence, risk factors, and consequences of PoAF. Results PoAF occurred in 35/338 (10.4%) patients and was significantly more frequent in older patients, with a best predictive value of 71 years at ROC curve analysis (AUC 0.70, p < 0.001) and in those with chronic renal failure (p = 0.01). The left atrial area was also significantly associated with the risk of PoAF (AUC 0.78, p = 0.000). PoAF was more frequent in patients with small cell and squamous cell carcinoma (p = 0.03). The occurrence of PoAF was associated with a longer hospital stay (p = 0.001) but not with higher long-term mortality (follow-up mean length: 3.3 ± 0.3 years). At multivariable analysis, the only independent predictors of PoAF were age (OR for 1-year increase 1.089, 95% CI 1.039–1.141, p 0.001) and open surgery (OR 2.07, 95% CI 1.0–4.29, p 0.047). At the 3-year follow-up, all patients were in sinus rhythm. Conclusions The present study shows the association between age and open surgery with PoAF, furtherly highlighting that the incidence of arrhythmia leads to a longer hospital stay. Left atrium dilatation could identify at-risk patients. Those results suggest that older patients — especially those with larger left atrium areas — might benefit most from a VATS approach to further reduce the arrhythmia incidence. Such a finding supports the indication of a systematic echocardiographic evaluation before elective lung surgery, especially in patients with known clinical risk factors.

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