Abstract
Postoperative atrial fibrillation (POAF), the most frequent arrhythmia after pulmonary resection, is a cause of both morbidity and mortality. Being able to predict the risk of POAF before surgery would help us evaluate the surgical risk and plan prophylaxis. We investigated the reported preoperative risk factors associated with the incidence of POAF and found that the recommended predictive factors were quite variable. Therefore, we evaluated the previously reported preoperative risk factors for POAF using our institutional data. We discuss our findings in this short review. Male gender, resected lung volume, brain natriuretic peptide (BNP), and left ventricular early transmitral velocity/mitral annular early diastolic velocity (E/e′) calculated by echocardiography were suggested as independent predictors for POAF, but the predictive values of each individual parameter were not high. The lack of definitive predictors for POAF warrants further investigations by gathering the reported knowledge, to establish an effective preoperative examination strategy.
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References
Cardinale D, Martinoni A, Cipolla CM, Civelli M, Lamantia G, Fiorentini C, et al. Atrial fibrillation after operation for lung cancer: clinical and prognostic significance. Ann Thorac Surg. 1999;68:1827–31.
Roselli EE, Murthy SC, Rice TW, Houghtaling PL, Pierce CD, Karchmer DP, et al. Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg. 2005;130:438–44.
Sekine Y, Kesler KA, Behnia M, Brooks-Brunn J, Sekine E, Brown JW. COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. Chest. 2001;120:1783–90.
Onaitis M, D’Amico T, Zhao Y, O’Brien S, Harpole D. Risk factors for atrial fibrillation after lung cancer surgery: analysis of the Society of Thoracic Surgeons general thoracic surgery database. Ann Thorac Surg. 2010;90:368–74.
Amar D, Roistacher N, Burt M, Reinsel RA, Ginsberg RJ, Wilson RS. Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest. 1995;108:349–54.
Nojiri T, Inoue M, Takeuchi Y, Maeda H, Shintani Y, Sawabata N, et al. Impact of cardiopulmonary complications of lung cancer surgery on long-term outcomes. Surg Today. 2015;45:740–5.
Lee CY, Bae MK, Lee JG, Kim KW, Park IK, Chung KY. N-terminal pro-B-type natriuretic peptide is useful to predict cardiac complications following lung resection surgery. Korean J Thorac Cardiovasc Surg. 2011;44:44–50.
Dyszkiewicz W, Skrzypczak M. Atrial fibrillation after surgery of the lung: clinical analysis of risk factors. Eur J Cardiothorac Surg. 1998;13:625–8.
Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study. J Cardiothorac Surg. 2012;7:4.
Vaporciyan AA, Correa AM, Rice DC, Roth JA, Smythe WR, Swisher SG, et al. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004;127:779–86.
Park BJ, Zhang H, Rusch VW, Amar D. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007;133:775–9.
Amar D, Burt M, Reinsel RA, Leung DH. Relationship of early postoperative dysrhythmias and long-term outcome after resection of non-small cell lung cancer. Chest. 1996;110:437–9.
von Knorring J, Lepantalo M, Lindgren L, Lindfors O. Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer. Ann Thorac Surg. 1992;53:642–7.
Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002;96:352–6.
Amar D, Zhang H, Shi W, Downey RJ, Bains MS, Park BJ, et al. Brain natriuretic peptide and risk of atrial fibrillation after thoracic surgery. J Thorac Cardiovasc Surg. 2012;144:1249–53.
Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, et al. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation. 2007;115:1339–44.
Nojiri T, Maeda H, Takeuchi Y, Funakoshi Y, Maekura R, Yamamoto K, et al. Predictive value of preoperative tissue Doppler echocardiographic analysis for postoperative atrial fibrillation after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg. 2010;140:764–8.
Rena O, Papalia E, Oliaro A, Casadio C, Ruffini E, Filosso PL, et al. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg. 2001;20:688–93.
Ciriaco P, Mazzone P, Canneto B, Zannini P. Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone. Eur J Cardiothorac Surg. 2000;18:12–6.
Curtis JJ, Parker BM, McKenney CA, Wagner-Mann CC, Walls JT, Demmy TL, et al. Incidence and predictors of supraventricular dysrhythmias after pulmonary resection. Ann Thorac Surg. 1998;66:1766–71.
Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg. 1993;106:1104–10.
Hollings DD, Higgins RS, Faber LP, Warren WH, Liptay MJ, Basu S, et al. Age is a strong risk factor for atrial fibrillation after pulmonary lobectomy. Am J Surg. 2010;199:558–61.
Nojiri T, Maeda H, Takeuchi Y, Funakoshi Y, Kimura T, Maekura R, et al. Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer. Eur J Cardiothorac Surg. 2010;37:787–91.
Raman T, Roistacher N, Liu J, Zhang H, Shi W, Thaler HT, et al. Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery. J Thorac Cardiovasc Surg. 2012;143:482–7.
Passman RS, Gingold DS, Amar D, Lloyd-Jones D, Bennett CL, Zhang H, et al. Prediction rule for atrial fibrillation after major noncardiac thoracic surgery. Ann Thorac Surg. 2005;79:1698–703.
Xin Y, Hida Y, Kaga K, Iimura Y, Shiina N, Ohtaka K, et al. Left lobectomy might be a risk factor for atrial fibrillation following pulmonary lobectomy. Eur J Cardiothorac Surg. 2014;45:247–50.
Ivanovic J, Maziak DE, Ramzan S, McGuire AL, Villeneuve PJ, Gilbert S, et al. Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection. Interact CardioVasc Thorac Surg. 2014;18:340–6.
Ciszewski P, Tyczka J, Nadolski J, Roszak M, Dyszkiewicz W. Lower preoperative fluctuation of heart rate variability is an independent risk factor for postoperative atrial fibrillation in patients undergoing major pulmonary resection. Interact CardioVasc Thorac Surg. 2013;17:680–6.
Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med. 1998;129:279–85.
Harpole DH, Liptay MJ, DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Prospective analysis of pneumonectomy: risk factors for major morbidity and cardiac dysrhythmias. Ann Thorac Surg. 1996;61:977–82.
Brathwaite D, Weissman C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest. 1998;114:462–8.
Massie E, Valle AR. Cardiac arrhythmias following total pneumonectomy. Proc Am Fed Clin Res. 1945;2:6.
Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139:366–78.
Villamizar NR, Darrabie MD, Burfeind WR, Petersen RP, Onaitis MW, Toloza E, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009;138:419–25.
Nojiri T, Yamamoto K, Maeda H, Takeuchi Y, Funakoshi Y, Inoue M, et al. Effect of low-dose human atrial natriuretic peptide on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer: a double-blind, placebo-controlled study. J Thorac Cardiovasc Surg. 2012;143:488–94.
Al-Omari MA, Finstuen J, Appleton CP, Barnes ME, Tsang TS. Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation. Am J Cardiol. 2008;101(1759–65):36.
Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll ardiol. 2002;40:1636–44.
Nojiri T, Inoue M, Yamamoto K, Maeda H, Takeuchi Y, Nakagiri T, et al. Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery. Surg Today. 2014;44:285–90.
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We thank Dr. Hajime Kasai from the Department of Respirology, Chiba University Graduate School of Medicine, for helping create the figure for this article.
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Iwata, T., Nagato, K., Nakajima, T. et al. Risk factors predictive of atrial fibrillation after lung cancer surgery. Surg Today 46, 877–886 (2016). https://doi.org/10.1007/s00595-015-1258-4
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DOI: https://doi.org/10.1007/s00595-015-1258-4