From the Guidelines
Atrial Fibrillation (AF) is the most common cardiac arrhythmia after pulmonary surgery.
Key Findings
- The incidence of postoperative AF after thoracic surgery is dramatically higher (4%–37%) than after nonthoracic surgery 1.
- A review of patients who underwent pulmonary surgery found an incidence of AF ranging from 3.2% to 30%, with most patients returning to normal sinus rhythm before discharge 1.
- The overall incidence of postoperative AF after pulmonary resection was found to be 11.8%, with a quarter of patients experiencing AF in the first 24 hours, and the incidence peaking at 2.5 days postoperatively 1.
- The incidence of new postoperative AF was reported to be 16% to 17% with open thoracotomy and 10% to 12% with a video-assisted thoracic approach to pulmonary lobectomy 1.
Clinical Implications
- Electrocardiographic monitoring is recommended through postoperative day 2 to 3 for pulmonary resection, with longer periods determined by the clinician for those with multiple risk factors 1.
- Patients with postoperative AF had a significantly longer mean length of stay (10.5 versus 6.9 days) 1.
- Postoperative AF can have significant hemodynamic consequences, potential for systemic embolization, and may require long-term prophylactic medication 1.
From the Research
Cardiac Arrhythmias after Pulmonary Surgery
- The most common cardiac arrhythmia after pulmonary surgery is atrial fibrillation (AF) 2, 3, 4.
- Supraventricular tachyarrhythmias, including AF, occurred in 22.3% of patients undergoing pulmonary resection 5.
- Postoperative atrial fibrillation (POAF) is a common complication of pulmonary resection, causing both morbidity and mortality 2.
Risk Factors for Atrial Fibrillation
- Male gender, resected lung volume, brain natriuretic peptide (BNP), and left ventricular early transmitral velocity/mitral annular early diastolic velocity (E/e') are suggested as independent predictors for POAF 2.
- Increases in mean heart rate and coefficient of variation (CV) of heart rate, older patients, intraoperative blood transfusion, and left thoracotomy are associated with arrhythmias 5.
- History of AFib and early postoperative AFib are relevant predictors of AFib occurrence 4.
Incidence of Atrial Fibrillation
- The incidence of AFib after lung transplantation is higher than after heart transplantation 3.
- The pooled incidence rate of late atrial arrhythmia after lung transplantation is 4.3%/year, while the late AFib incidence rate is 1.5%/year 4.
- A longer follow-up duration is significantly related to the reduced incidence rate of AFib 4.