New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre

Garner, Megan; Routledge, Tom; King, Juliet; Pilling, John; Veres, Lukács; Harrison-Phipps, Karen; Billè, Andrea; Harling, Leanne

doi:10.1093/icvts/ivw348

Cited by 21 publications

(21 citation statements)

References 26 publications

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“…26 Furthermore, thoracic surgical patients, including the patients in this unit, have a high risk (20-30%) of postoperative atrial fibrillation. 27,28 In this study nine (90%) patients who developed ischemic bowel suffered an episode of atrial fibrillation postoperatively. The resulting decrease in cardiac output or increase risk of embolic disease could have reduced blood flow to the bowel despite all these patients receiving prophylactic anticoagulation.…”

Section: Discussionmentioning

confidence: 70%

Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Smelt

Martin

Al-Sahaf

et al. 2018

Thorac Cardiovasc Surg

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Introduction Respiratory failure has historically been the major cause of mortality after elective lung resections. With improved intubation using fiber-optic scopes, better preoperative respiratory risk assessment, more advanced anesthetic single lung ventilation, and minimally invasive surgical technique, this may have changed. Our objective was to assess the main causes of mortality over the past 10 years in patients undergoing elective lung surgery in a major UK center. Materials and Methods A retrospective unit data search was made for all deaths during the 10-year period between January 2007 and December 2016 inclusive. All inpatient deaths within 30 days of an elective anatomical lung resection for lung malignancies were included. Results Three-thousand three-hundred sixteen lung resections for malignancy were performed in the 10-year period. There were 44 (1.3%) deaths during this period, 27 (61.4%) after open lobectomies, 8 (18.2%) after video-assisted thoracoscopic surgery lobectomies, 5 (11.4%) after sleeve lobectomies, and 4 (9%) after pneumonectomies. Causes of death included 24 (54.5%) respiratory failure, 10 (22.7%) ischemic bowel, 4 (9%) coronary events, 2 (4.5%) strokes, 2 (4.5%) on table hemorrhage, 1 (2.3%) massive pulmonary embolus, and 1 (2.3%) postoperative hemorrhage. Conclusion Although respiratory failure is still a major cause of mortality in the postoperative patient, bowel ischemia has been found to be the second greatest cause of death. This study highlights the need to identify those at risk of this fatal complication during preoperative assessment and their postoperative management.

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Section: Discussionmentioning

confidence: 70%

Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Smelt

Martin

Al-Sahaf

et al. 2018

Thorac Cardiovasc Surg

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“…In particular, recent papers showed how, in non-cardiac surgery, atrial fibrillation recurrences were 37.28% in patients with PAF and 1.51% in those without [11]. In recent work on 377 patients who underwent anatomical pulmonary resection, the persistence of one-month arrhythmia was 7% [120]. Even more recently, Higuchi et al have shown a recurrence rate of 30% atrial fibrillation, mainly asymptomatic, in subjects undergoing cancer surgery, associated with the presence of arterial hypertension and renal failure [121].…”

Section: Long Term Implications Of Pafmentioning

confidence: 99%

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Fabiani

Colombo

Bacchiani

et al. 2019

JCM

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Atrial fibrillation (AF) is a common supraventricular arrhythmia, a recognized risk factor for ischemic stroke, as a potential driver for heart failure (HF). Cancer patients have an increased risk for AF, even not including any cancer-specific treatment, as surgery or chemotherapy. The mechanism is multifactorial, with inflammation and changes in autonomic tone as critical actors. Commonly, AF is a recurrent complication of the post-operative period in cancer surgery (especially thoracic). Recent papers confirmed a significant incidence of post-operative (non-cardiac surgery) AF (PAF), partially mitigated by the use of prophylactic (rate o rhythm control) treatments. A relevant difference, in terms of mean hospitalization time, emerges between patients developing PAF and those who do not, while long term impact remains a matter of debate, due to several potential confounding factors. Besides clinical predictors, structural (i.e., echocardiographic) and bio-humoral findings may help in risk prediction tasks. In this respect, pre-operative natriuretic peptides (NPs) concentrations are nowadays recognized as significant independent predictors of perioperative cardiovascular complications (including PAF), while elevated post-operative levels may further enhance risk stratification. The aim of the present paper is to trace the state of the art in terms of incidence, management, prevention, and outcome of PAF in the field of thoracic surgical oncology.

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“…As said before, the most studied type of AF is the postoperative AF (POAF), especially after pulmonary resection for lung cancer [ 18 ][ 19 ]. Even 12.6% of 13,906 patients who underwent lung cancer surgery developed POAF [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Cancer increases the risk of atrial fibrillation during long-term follow-up (OPERA study)

Kattelus¹,

Kesäniemi²,

Huikuri³

et al. 2018

PLoS ONE

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IntroductionRelation between atrial fibrillation (AF) and cancer is known but not very well understood. The purpose of this prospective study was to find out whether subjects with cancer were at greater risk of AF than subjects without cancer.Materials and methodsThe study was based on the OPERA (Oulu Project Elucidating Risk of Atherosclerosis) material and had 1045 subjects and the mean follow-up time of 16.3 years. During the follow-up AF and cancer diagnosis were made (atrial flutter included) if these events were listed in the National Death Registry and/or hospital discharge registry.ResultsIn this study 130 subjects (12%) had cancer and 19% of these had AF, whereas only 9% of those without cancer experienced AF during the follow-up (p<0.001). Subjects in the cancer group had greater probability of developing atrial fibrillation during the follow-up time in comparison to the subjects without cancer (Hazard ratio (HR) 2.47 (95%CI) 1.57–3.88) in multivariate model including relevant confounding factors.ConclusionThe main finding of this OPERA study was that cancer is an independent risk factor of atrial fibrillation. Still it remains unclear whether this association is causative or whether cancer and atrial fibrillation just share the same pathophysiologic mechanisms.

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New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre

Cited by 21 publications

References 26 publications

Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Cancer increases the risk of atrial fibrillation during long-term follow-up (OPERA study)

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