Is there a role for prophylaxis against atrial fibrillation for patients undergoing lung surgery?

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether prophylactic anti-arrhythmic drugs may prevent atrial fibrillation (AF) following lung resection. Altogether 457 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We identified single randomized trials that have demonstrated a benefit for Diltiazem, Bupivacaine epidural and magnesium for prophylaxis against AF in patients undergoing non-cardiac thoracic surgery, with a number needed to treat of between 4 and 8 with these regimes.

Acute and Subacute Awake Injection Laryngoplasty for Thoracic Surgery Patients

“…10 Other arrhythmias, myocardial ischemia, pulmonary edema, embolism, and shunt have also been described as possible postoperative complications of noncardiac thoracic surgery. [10][11][12] The risk of developing such conditions following thoracic procedures may surpass the potential benefit of surgical procedures under anesthesia. Therefore, procedures that can be performed under local anesthesia lessen interventional risk to postoperative thoracic surgery patients.…”

Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery

“…1 Postoperative atrial fibrillation has been associated with increased intensive care unit and hospital length of stay, morbidity, mortality, hospital readmission, and longterm risk of stroke. [2][3][4] Hence, prediction and prevention of PAF represent very important goals from a clinical point of view.…”

Supraventricular Arrhythmias after Thoracotomy: Is There a Role for Autonomic Imbalance?

“…Thoracic epidural anesthesia is regarded as the most reliable treatment for postthoracotomy pain management [52, 53]. TEA with administration of local anesthetics shows a prophylactic effect on postoperative dysrhythmias after thoracotomy [8, 54, 55]. These observations are somehow indicative of a relationship between postthoracotomy pain and the appearance of arrhythmias during the postoperative period.…”