Postoperative Atrial Fibrillation in Lung Cancer Lobectomy—Analysis of Risk Factors and Prognosis

Abstract

Background The incidence of postoperative atrial fibrillation (POAF) after pulmonary lobectomy ranges from 6.4 to 12.6%. This study aimed to analyze the postoperative risk factors and prognosis for POAF in lobectomy for lung cancer. Methods Data were collected from patients undergoing pulmonary lobectomy from April 2010 to March 2019. We analyzed risk factors for POAF among perioperative factors and compared postoperative complications or overall survival between POAF and non‐POAF groups. We classified POAF as either the temporary or non‐temporary type and compared perioperative factors, postoperative complications, and overall survival. Results POAF was identified in 49 (5.2%) of the 947 lobectomies. The POAF group included more males, patients with poor performance status (PS), history of paroxysmal atrial fibrillation (AF), chronic obstructive pulmonary disease (COPD), and intraoperative blood transfusions. Poor PS, COPD, previous paroxysmal AF, and intraoperative blood transfusion were independent risk factors for POAF in multivariate analysis. The POAF group had a poorer prognosis than the non‐POAF group (p = 0.0045). POAF was divided into 29 temporary and 20 non‐temporary types. The onset date of non‐temporary‐type POAF was significantly later than that of the transient type (P < 0.01), and diabetes mellitus was significantly higher in non‐temporary‐type POAF. Non‐temporary‐type POAF had a significantly poorer prognosis in terms of overall survival (p = 0.005). Conclusions Poor PS, COPD, history of PAF, and intraoperative blood transfusion were independent risk factors for POAF. Non‐temporary‐type POAF occurred significantly later than transient type and caused poorer prognosis after lobectomy for lung cancer.

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management

“…Heart failure (HF), arterial hypertension, chronic obstructive pulmonary disease (COPD), and a history of myocardial infarction significantly increased the risk [18]. In addition, male sex, obesity, previous episodes of AF, and poor performance status have been shown to be associated with an increased risk of POAF [4,6,19].…”

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

“… 53 Additionally, CHF may act synergistically with advanced age to increase the risk for POAF development. 53 Similarly, thoracic surgery, 54 HR, 46 atrial pressure, 55 and a history of paroxysmal AF 56 have been implicated in POAF development. Blood loss during surgery may increase oxidative stress and cause sympathetic/parasympathetic activation, resulting in POAF.…”

Evaluation of gastroesophageal reflux disease and hiatal hernia as risk factors for lobectomy complications

“…Atrial fibrillation remains one of the most common complications after pulmonary resection and has been associated with increased short-term morbidity, mortality, and decreased long-term survival. 6 , 22 Previous studies have described an association between hiatal hernia and atrial fibrillation in the general hospital population and among patients scheduled for cardiac ablation. 14 , 23 While the mechanism is unknown, hiatal hernia has been hypothesized to cause atrial fibrillation through direct mechanical or reflux-induced inflammatory irritation of the left atria.…”

“…Although radiation therapy has been implicated as a risk factor for atrial fibrillation and other arrhythmias in cancer patients, presumably through injury and fibrosis of the cardiac conduction system, 37 other studies failed to find an association. 6 , 38 …”

“…For example, patient sex, advanced age, and tobacco smoking, all predict greater rates of complications after pulmonary resection for lung cancer. 4 , 5 , 6 Risk stratification based on patient attributes may not only improve shared decision-making and patient selection but also may expose opportunities to mitigate risk.…”