Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy.

Abstract

OBJECTIVE:

The objective was to define the incidence of atrial fibrillation after video-assisted thoracic surgery lobectomy and determine whether video-assisted thoracic surgery reduces atrial fibrillation rate compared with thoracotomy.

METHODS:

With the use of a single-institution database of patients who underwent lobectomy for clinical stage I non-small cell lung cancer, 389 patients were identified who were in sinus rhythm preoperatively and received no prophylactic antiarrhythmics. Patients undergoing video-assisted thoracic surgery were age and gender matched with those undergoing thoracotomy.

RESULTS:

After matching, 122 patients undergoing video-assisted thoracic surgery and 122 patients undergoing thoracotomy were eligible for analysis. Patients undergoing video-assisted thoracic surgery had a higher preoperative diffusion capacity (92% +/- 28% vs 80% +/- 18% predicted, P = .001) and a lower rate of induction chemotherapy (5/122, 4% vs 11/122, 11%, P = .05) than patients undergoing thoracotomy. Atrial fibrillation occurred in 12% of patients (15/122) undergoing video-assisted thoracic surgery and 16% of patients (20/122) undergoing thoracotomy (P = .36). Overall, complications were lower in the video-assisted thoracic surgery group (17.2% vs 27.9%, P = .046). Patients with atrial fibrillation were older in both video-assisted thoracic surgery (73 +/- 7 years vs 66 +/- 9 years, P = .002) and thoracotomy groups (72 +/- 7 years vs 66 +/- 10 years, P = .005). Length of stay for patients with atrial fibrillation was greater in both video-assisted thoracic surgery (6.0 +/- 1.5 days vs 4.7 +/- 2.5 days, P = .01) and thoracotomy groups (9.2 +/- 4.3 days vs 6.8 +/- 3.6 days, P = .03).

CONCLUSIONS:

Regardless of surgical approach, atrial fibrillation after lobectomy occurred with equal frequency. This supports the theory that autonomic denervation and stress-mediated neurohumoral mechanisms are responsible for the pathogenesis of postoperative atrial fibrillation. Prophylaxis regimens against atrial fibrillation should be the same for either operative approach.

• Authors: Bernard J Park, Hao Zhang, Valerie W Rusch, David Amar
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 133 Issue 3 Pg. 775-9 (Mar 2007) ISSN: 1097-685X [Electronic] United States
• PMID: 17320583 (Publication Type: Journal Article)

Topics

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Atrial Fibrillation (diagnosis, epidemiology, etiology)
• Carcinoma, Non-Small-Cell Lung (pathology, surgery)
• Electrocardiography
• Female
• Humans
• Incidence
• Lung Neoplasms (pathology, surgery)
• Male
• Middle Aged
• Pneumonectomy (adverse effects, methods)
• Probability
• Prognosis
• Severity of Illness Index
• Sex Distribution
• Thoracic Surgery, Video-Assisted (adverse effects, methods)
• Thoracotomy (adverse effects, methods)
• Treatment Outcome