Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection

Abstract

While the majority of PAF is uncomplicated and transient, one-third of cases lead to persistence or major intervention. Age, coronary artery disease and extent of surgery/stage increase the risk of PAF following pulmonary resection. Identifying patients with elevated risk may lead to targeted prophylaxis to reduce the incidence of PAF.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…314,318 Ivanovic et al 316 reported a similar incidence (11.8%) of a new documented postoperative AF that required pharmaco logical therapy among patients undergoing pulmonary resection (n=363). Patients with postoperative AF had a significantly longer mean length of stay (10.5 versus 6.9 days).…”

“…In a consecutive sample of patients undergoing pulmo nary resection, the overall incidence of postoperative AF was 11.8%, with a quarter of patients experiencing AF in the first 24 hours; the incidence peaked at 2.5 days postoperatively. 316 Other investigators noted that AF develops most frequently 2 days after noncardiac thoracic surgery. 315,317 Thus, it is reasonable to recom mend electrocardiographic monitoring through postop erative day 2 to 3 for pulmonary resection, with longer periods determined by the clinician for those with mul tiple risk factors.…”

“…313 For patients who undergo thoracic surgery even without direct cardiac involvement, the incidence of postoperative AF is dramatically higher (4%-37%) than for those who undergo nonthoracic surgery. [313][314][315][316] Heterogeneity of samples and methods contributes to a lack of understanding of the true inci dence. A review spanning 2002 to 2012 noted a 3.2% to 30% incidence of SVT after pulmonary surgery, with return to normal sinus rhythm before discharge for most patients.…”

“…Patients with postoperative AF had a significantly longer mean length of stay (10.5 versus 6.9 days). Ivanovic et al 316 described the AF as mainly tran sient and uncomplicated; however, one third of cases either were not transient or led to a major intervention. Sohn et al 315 reported that patients who developed AF had a longer hospitalization and increased inhospital mortality (although the cause of death was noncardio vascular such as pneumonia or hemorrhage).…”

Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?

“…New-onset AF is a common arrhythmic complication of critical illness, with an incidence that varies from 4 to 9% in general intensive care unit patients, to 32 to 50% in patients after major cardiac and thoracic surgery. (1)(2) New-onset AF is associated with increased morbidity and mortality in patients hospitalized for heart failure, as well as various other critical conditions, although it is possible that AF in these cases is primarily a marker of disease severity rather than a direct cause of death. (3,4) AF is associated with cardioembolic events and heart failure, longer hospital stays, and reduced quality of life as well as a two to five-fold increased mortality.…”