Association between Postoperatively Developed Atrial Fibrillation and Long-Term Mortality after Esophagectomy in Esophageal Cancer Patients: An Observational Study

Abstract

BackgroundNewly developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. However, the clinical implications of AF have not been fully elucidated in these patients. This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy.MethodsThis study evaluated 583 patients undergoing esophagectomy, from January 2005 to April 2012. AF was defined as newly developed postoperative AF requiring treatment. The risk factors for AF and the association between AF and mortality were evaluated. The long-term mortality was the all-cause mortality, for which the cutoff date was May 31, 2014.ResultsAF developed in 63 patients (10.8%). Advanced age (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.056–1.144, P < 0.001), preoperative calcium channel blocker (CCB) (OR 2.339, 95% CI 1.143–4.786, P = 0.020), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR 0.206, 95% CI 0.067–0.635, P = 0.006) were associated with the incidence of AF. The Kaplan-Meier curve showed a significantly lower survival rate in the AF group compared to the non-AF group (P = 0.045), during a median follow-up of 50.7 months. The multivariable analysis revealed associations between AF and the 1-year mortality (hazard ratio [HR] 2.556, 95% CI 1.430–4.570, P = 0.002) and between AF and the long-term mortality (HR 1.507, 95% CI 1.003–2.266, P = 0.049).ConclusionsIn esophageal cancer patients, the advanced age and the preoperative medications (CCB, ACEI or ARB) were associated with the incidence of AF. Furthermore, postoperatively developed AF was associated with mortality in esophageal cancer patients after esophagectomy, suggesting that a close surveillance might be required in patients who showed AF during postoperative period.

Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer

“…In the present study, the incidence of postoesophagectomy AF in the placebo group was 30 per cent, similar to previous reports. Mechanisms of AF after oesophagectomy remain unclear, although it may be partially explained by surgical trauma to the cardiac fibres of the sympathetic and parasympathetic nerves.…”

“…Participants were enrolled in the trial, with a 1 : 1 parallel allocation ratio, between March 2013 to January 2016. Patients were eligible if they met the following criteria: pathologically confirmed thoracic oesophageal carcinoma; planned right transthoracic oesophagectomy with two‐ or three‐field lymph node dissection; clinical stage I, II, III or IV (M1 lymph node) according to the UICC TNM classification (7th edition); Eastern Cooperative Oncology Group performance status 0–1; age 20–85 years; and normal major organ function as indicated by a leucocyte count of 3000–12 000 per mm, neutrophil count exceeding 1500 per mm, platelet count of over 100 000 per mm 3 , haemoglobin level greater than 8·0 g/dl, aspartate and alanine aminotransferase levels below 150 units/l, and creatinine level less than 1·5 mg/dg. Patients with a resting heart rate (HR) below 50 beats per min, second‐ or third‐degree atrioventricular block, and a history of AF were excluded.…”

“…Oesophagectomy for cancer is high‐risk surgery with considerable morbidity and mortality. New‐onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9–46 per cent. This new‐onset AF may be associated with complications, directly by increasing the risks of embolic events and ischaemic events, and indirectly by increasing complications through haemodynamic instability and organ hypoperfusion.…”

“…New-onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9-46 per cent 2 -8 . This new-onset AF may be associated with complications 2,3,8 , directly by increasing the risks of embolic events and ischaemic events, and indirectly by increasing complications through haemodynamic instability and organ hypoperfusion. In this way, AF may be associated with respiratory complications, anastomotic leak and severe infection 2 .…”

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

“…Mc Cormack et al 60 Chin et al 58 Seesing et al 28 Rao et al 55 Stawicki et al 30 Hou et al 33 Murthy et al 36 Overall ( Odds ratios for risk of atrial fibrillation (AF) in a smokers versus non-smokers, and b patients with chronic obstructive pulmonary disease (COPD) versus no COPD. c Mean difference in age between patients with versus without AF.…”