Postoperative atrial fibrillation after thoracic surgery (PoAF): risk factors and outcome

Background Postoperative AF (PoAF) is a common complication of the early postoperative period of noncardiac, thoracic surgery and is associated with prolonged hospital stay. In order to investigate the predictors of PoAF in the specific setting of lung surgery of oncologic patients, we retrospectively analyzed 338 consecutive patients admitted to our department to be operated for lung cancer with a thoracotomy approach (i.e., open surgery). We determined this population's prevalence, risk factors, and consequences of PoAF. Results PoAF occurred in 35/338 (10.4%) patients and was significantly more frequent in older patients, with a best predictive value of 71 years at ROC curve analysis (AUC 0.70, p < 0.001) and in those with chronic renal failure (p = 0.01). The left atrial area was also significantly associated with the risk of PoAF (AUC 0.78, p = 0.000). PoAF was more frequent in patients with small cell and squamous cell carcinoma (p = 0.03). The occurrence of PoAF was associated with a longer hospital stay (p = 0.001) but not with higher long-term mortality (follow-up mean length: 3.3 +/- 0.3 years). At multivariable analysis, the only independent predictors of PoAF were age (OR for 1-year increase 1.089, 95% CI 1.039-1.141, p 0.001) and open surgery (OR 2.07, 95% CI 1.0-4.29, p 0.047). At the 3-year follow-up, all patients were in sinus rhythm. Conclusions The present study shows the association between age and open surgery with PoAF, furtherly highlighting that the incidence of arrhythmia leads to a longer hospital stay. Left atrium dilatation could identify at-risk patients. Those results suggest that older patients - especially those with larger left atrium areas - might benefit most from a VATS approach to further reduce the arrhythmia incidence. Such a finding supports the indication of a systematic echocardiographic evaluation before elective lung surgery, especially in patients with known clinical risk factors. Highlights Key findings center dot In a setting of lung cancer surgical patients, postoperative atrial fibrillation (PoAF) is more frequent in older patients and in those with larger left atrial dimension. What is known and what is new? center dot Left atrial area is a known predictor of atrial fibrillation after cardiac surgery. center dot Only few data reported the association of left atrial area with atrial fibrillation after thoracic surgery for lung cancer What is the implication and what should change now? center dot Echocardiography should be part of preoperative evaluation of all patients undergoing thoracic surgery for lung cancer. center dot In order to further reduce the risk of PoAF, video-assisted thoracic surgery might be the preferred surgical approach to be proposed for older patients with larger left atrial area.