Incidence of atrial fibrillation after extrapleural pneumonectomy vs. pleurectomy in patients with malignant pleural mesothelioma

Abstract

Extrapleural pneumonectomy (EPP) and pleurectomy are the surgical procedures for the treatment of pleural mesothelioma. However, EPP increases the risk for postoperative atrial fibrillation (AF). We conducted a retrospective chart review of 130 patients who underwent EPP or pleurectomy. Seventy patients (excluding three patients with a prior history of AF) underwent EPP and 57 patients underwent pleurectomy. The mean ages were 60+/-11 and 63+/-13 years, and the male to female ratios were 50/20 and 44/13, respectively. Postoperative AF was observed in 45 patients with 36 (51%) of these cases occurring after EPP and 9 (17%) after pleurectomy (P<0.0001). There were no significant differences between the two treatment groups for gender, age, side of affected lung, preoperative heart rate, history of beta-blocker use, coronary heart disease, and chronic obstructive pulmonary disease. Through logistic regression, EPP (OR=7.1, 95% CI: 2.9, 17.8) and age over 65 years (OR=2.9, 95% CI: 1.2, 6.8) were found to be risk factors for AF. We conclude that EPP vs. pleurectomy and age over 65 years are risk factors for postoperative AF. The increased odds of having AF after EPP could be due to right heart stress caused by pneumonectomy.

Predictive Factors of Supraventricular Arrhythmias after Noncardiac Thoracic Surgery: A Multicenter Study

“…The association between age and supraventricular arrhythmias was closely examined in many series [Neragi-Miandoab 2008;Rena 2001;Lanza 2003]. The findings were similar to our results, which support the association of increasing incidence of supraventricular arrhythmias with increasing age.…”

“…Thoracic surgery remains a high-risk procedure for many patients, and supraventricular cardiac arrhythmias, especially atrial fibrillation (AF), are the most common rhythm disturbances in this patient population [Vaporciyan 2004;Bobbio 2007;Von Knorring 1992;Neragi-Miandoab 2008]. Arrhythmias are associated with higher morbidity and longer hospital stay and, therefore, higher hospital costs, as well as with increased perioperative mortality and worse long-term survival [Ziomek 1993;Dyszkiewicz 1998;Krowka 1987;Gómez-Caro 2006].…”

“…Other risk factors include myocardial infarction, presence of coronary artery disease, and postoperative lung embolism. Few reports have analyzed risk factors associated with major complications or cardiac arrhythmias [Vaporciyan 2004;Neragi-Miandoab 2008;Rena 2001]. The main aim of our study was to ascertain whether there are factors that predispose to postoperative atrial fibrillation and, if so, how important they are from a clinical standpoint.…”

Screening of Pleural Mesotheliomas for DNA-damage Repair Players by Digital Gene Expression Analysis Can Enhance Clinical Management of Patients Receiving Platin-Based Chemotherapy

“…Homologue recombination (HR) and non-homologous end-joining (NHEJ) are of great importance, since DNA DSBs induce chromosomal deletions and translocations which are common in MPM 45 , 92 , 93 . Upregulation of various genes encoding HR protein members, including RAD50 , RAD54L , RAD21, BRCA1 and BRCA2 could be detected by gene expression analysis in MPM 62 , 94 .…”

Changes in lung function after surgery for mesothelioma

“…This is similar to the morbidity in other reports, whereas the mortality rate in this study was lower. 7,[19][20][21][22][23][24] Histology was identified as the significant factor influencing survival. There was no significant difference in survival between the EPP and the P/D groups, which is consistent with other studies.…”