Atrial Fibrillation after Noncardic Surgery

  • Dhiraj D. Narula
  • Jonathan S. Steinberg
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 222)


New onset atrial fibrillation is very common after cardiac surgery and though it occurs less frequently after other types of surgery, it is still a major clinical problem. With the large numbers of surgical procedures performed each year in the United States, even a small incidence translates into a significant absolute number of patients.


Atrial Fibrillation Lung Resection Adult Respiratory Distress Syndrome Pulmonary Resection Postoperative Atrial Fibrillation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Polanczyk CA, Goldmann 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; 129:279–285.PubMedGoogle Scholar
  2. 2.
    Knorring J, Lepantalo M, Lindgren L, Lindfors O. Cardiac arrhythmias and myocardial ishemia after thoracotomy for lung cancer. Ann Thorac Surg 1992;53:642–7.CrossRefGoogle Scholar
  3. 3.
    Currens JH, White PD, Churchill ED. Cardiac arrhythmias following thoracic surgery. N Engl J Med 1943;229:360–4.CrossRefGoogle Scholar
  4. 4.
    Bailey CC, Betts RH. Cardiac arrhythmias following pneumonectomy. N Engl J Med 1943;229:356–9.CrossRefGoogle Scholar
  5. 5.
    Massie E, Valle AR, Cardiac arrhythmias complicating total pneumonectomy. Ann Intern Med 1947;26:231–9.PubMedGoogle Scholar
  6. 6.
    Krosnick A, Wasserman F. Cardiac arrhythmias in the older age group following thoracic surgery. Am J Med Sci 1955;230:541–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen MG, Pastor BH. Delayed cardiac arrhythmias following non-cardiac thoracic surgery. Dis Chest 1957; 32:435.PubMedGoogle Scholar
  8. 8.
    Cemey CI. The prophylaxis of cardiac arrhythmias complicating pulmonary surgery. J Thorac Surg 1957;34:105–10.Google Scholar
  9. 9.
    Epstein EJ. Arrhythmias complicating the surgical treatment of lung carcinoma. British journal of Tuberculosis and Diseases of the Chest 1958; 52:195.CrossRefPubMedGoogle Scholar
  10. 10.
    Hurt RL, Bates M. The value of quinidine in the prevention of cardiac arrhythmias after pulmonary resection. Thorax 1958; 13:39.CrossRefPubMedGoogle Scholar
  11. 11.
    Shields TW. Factors influencing the morbidity and mortality in the older aged patient undergoing pulmonary surgery. Surg Gynec Obstet 1960; 111:598.Google Scholar
  12. 12.
    Wheat MW, Buford TH. Digitalis in surgery: extension of classical indications. J Thorac Cardiovasc Surg 1961; 41:162.PubMedGoogle Scholar
  13. 13.
    Catalayud JB, Kelser GA, Caseres CA. Incidence of cardiac arrhythmias following noncardiac surgery. J Thorac Cardiovasc Surg 1961; 41: 498.Google Scholar
  14. 14.
    Mowry FM, Reynolds EW Jr. Cardiac rhythm disturbances complicating resectional surgery of the lung. Ann Intern Med 1964;61:688–95.PubMedGoogle Scholar
  15. 15.
    Bergh NP, Dottori O, Malmberg R. Prphylactic digitalis in thoracic surgery. Scand J Resp Dis 1967; 48: 197.Google Scholar
  16. 16.
    Shields TN, Ujiki GT. Digitalisation for prevention of arrhythmias following pulmonary surgery. Surg Gynecol Obstet 1968.Google Scholar
  17. 17.
    Juler GL, Stemmer EA, Connolly SE. Complications of prophylactic digitalization in thoracic surgical patients. J Thorac Cardiovasc Surg 1969;58:352–60.PubMedGoogle Scholar
  18. 18.
    Stougard J. Cardiac arrhythmias following pneumonectomy. Thorax 1969; 24:568.CrossRefPubMedGoogle Scholar
  19. 19.
    Ghosh P, Pakrashi BC. Cardiac dysrhythmias after thoracotomy. Br Heart J 1972;34:474–6.Google Scholar
  20. 20.
    Burman SO. The prophylactic use of digitalis before thoracotomy. Ann Thorac Surg 1972;14:359–68.CrossRefPubMedGoogle Scholar
  21. 21.
    Beck-Neilsen J, Rahbek Sorensen H, Alstrup P. Atrial fibrillation following thoracotomy for non-cardiac diseases, in particular cancer of the lung. Acta Med Scand 1973; 193:425–429.CrossRefGoogle Scholar
  22. 22.
    Astrup P, Sorensen R. Metabolic studies following thoracotomy for lung cancer with particular reference to postoperative atrial fibrillation. Scand J Thorac Cardiovasc Surg 1975; 9:149–53.Google Scholar
  23. 23.
    Adebo OA, Singh AK. Digitalis in pneumonectomy and its implication. J Nat Med Assn 1979; 71:669.Google Scholar
  24. 24.
    Nagasaki F, Flehinger BJ, Martini N. Complications of surgery in treatment of carcinoma of the lung. Chest 1982;82:25–29.CrossRefPubMedGoogle Scholar
  25. 25.
    Keagy BA, Schorlemmer GR, Murray GF, Starek PJK, Wilcox BR. Correlation of preoperative pulmonary function testing with clinical course inpatients after pneumonectomy. Ann Thorac Surg 1983;36:253–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Keagy BA, Pharr WF, Bowes DE, Wilcox BR. A review of morbidity and mortality in elderly patients undergoing pulmonary resection. Am Surg 1984; 50:213–6.PubMedGoogle Scholar
  27. 27.
    Krowka MJ, Pairolero PC, Trastek VF, Payne WS, Bematz PE. Cardiac dysrhythmia following pneumonectomy: clinical correlates and prognostic significance. Chest 1987;91:490–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Mathisen DJ, Grillo HC, Wilkins EW Jr. Moncure AC, Hilgenberg AD. Transthoracic esophagectomy: a safe approach to carcinoma of the esophagus. Ann Thorac Surg 1988; 45:137–43.CrossRefPubMedGoogle Scholar
  29. 29.
    Schwarz RE, Posner MC, Ferson PF, Keenan RJ, Landreneau RJ. Thoracoscopic techniques for the management of intrathoracic metastases. Results. Surg Endosc 1998;12: 842–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Wahi R, McMurtney MJ, DeCaro LF et al. Determinants of perioperative morbidity and mortality after pneumonectomy. Ann Thor Surg 1989;48:33–7.CrossRefGoogle Scholar
  31. 31.
    Ritchie AJ, Bowe P, Gibbons JRP. Prophylactic digitalization for thoracotomy: a reassessment. Ann Thorac Surg 1990;50:86.CrossRefPubMedGoogle Scholar
  32. 32.
    Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. What are the risk factors for arrhythmias after thoracic operations. J Thorac Cardiovasc Surg 1993; 106:1104–1110.PubMedGoogle Scholar
  33. 33.
    Van Mieghem W, Coolen L, Malysse I, Lacquet L, Deneffe G, Demedts M. Amiodarone and the development of ARDS after lung surgery. Chest 1994;105:1642–45.CrossRefPubMedGoogle Scholar
  34. 34.
    McDonald ML, Deschamps C, Ilstrup DM, Allen MS, Trastek VF, Pairolero PC. Pulmonary resection for metastatic breast cancer. Ann Thorac Surg 1994; 58:1599–602.CrossRefPubMedGoogle Scholar
  35. 35.
    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: 349–354.CrossRefPubMedGoogle Scholar
  36. 36.
    Van Mieghem W, Tits G, Demuynck K, Lacquet L, Deneffe G, Tjandra-Maga T, Demedts M. Verapamil as prophylactic treatment for atrial fibrillation after lung operations. Ann Thorac Surg 1996; 61: 1083–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Allen MS, Deschamps C, Jones DM, Trastek VF, Pairolero PC. Video-assisted thoracic surgical procedures: the Mayo experience. Mayo Clin Proc 1996; 71:351–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Terzi A, Furlan G, Chiavacci P, Dal Corso B, Luzzani A, Dalla Volta S. Prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery by infusion of magnesium sulfate. Thorac Cardiovasc Surg 1996; 44: 300–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Swanson SJ, Mentzer SJ, DeCamp MM Jr., Bueno R, Richards WG, Ingenito EP, Reilly JJ, Sugarbaker DJ. No-cut thoracoscopic lung plication: a new technique for lung volume reduction surgery. J Am Coll Surg 1997; 185:25–32.PubMedGoogle Scholar
  40. 40.
    Jacobsen CJ, Bille S, Ahlburg P, Rybrol L, Hjortholm R, Andresen EB. Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection. J Cardiothorac Vasc Anesth 1997; 11:746–51.CrossRefGoogle Scholar
  41. 41.
    Benjamin EJ, Levy D, Vaziri S, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. J Am Med Assoc 1994; 271:840–4.CrossRefGoogle Scholar
  42. 42.
    Leitch JW, Thomson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990;100:338–42.PubMedGoogle Scholar
  43. 43.
    Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multicenter Study of Perioperative Ischemia Research Group. J Am Med Assoc 1996;276:300–6.CrossRefGoogle Scholar
  44. 44.
    Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammermeister KE. Atrial fibrillation after cardiac surgery: a major morbid event?. Ann Surg 1997;226:501–513.CrossRefPubMedGoogle Scholar
  45. 45.
    Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, Collins JJ Jr, Cohn LH, Burstin HR. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94:390–7.PubMedGoogle Scholar
  46. 46.
    Gerson MC, Hurst JM, Hertzberg VS, Baugham R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990;88:101–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Breyer RH, Zippe C, Pharr WF, Jensik RJ, Kittle CF, Faber LP. Thoracotomy in patients over age seventy years: ten-year experience. J Thorac Cardiovasc Surg 1981; 81:187–93.PubMedGoogle Scholar
  48. 48.
    Szentmiklosi AJ, Nementh M, Szegi J, Papp JG, Szekeres L. On the possible role of adenosine in the hypoxia-induced alteration sof the electrical and mechanical activity of the atrial myocardium. Arch Int Pharmacodyn 1979; 238: 283–95.PubMedGoogle Scholar
  49. 49.
    Page P, Plumb VJ, Okumura K, Waldo AL. A new model of atrial flutter. J Am Coll Cardiol 1986; 8:872–879.CrossRefPubMedGoogle Scholar
  50. 50.
    Kumagai K, Khrestian C, Waldo AL. Simultaneous multisite mapping studies during induced atrial fibrillation in the sterile pericarditis model. Insights into the mechanism of its maintainance. Circulation 1997; 95:511–21.PubMedGoogle Scholar
  51. 51.
    Craig SR, Walker WS. Initial experience of video assisted thoracoscopic pneumonectomy. Thorax 1995; 50: 392–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Borgeat A, Biollaz J, Bayer-Berger M, Kappenberger L, Chapuis G, Chiolero R. Prevention of arrhythmias by flecainide after noncardiac thoracic surgery. Ann Thorac Surg 1989;48:232–34.CrossRefPubMedGoogle Scholar
  53. 53.
    Sorensen O, Waaben KB, Skovsted P. The incidence of cardiac arrhythmias and arterial hypotension subsequent to standardized surgical stimuli in patients undergoing thoracotomy with special reference to enflurane and halothane. Acta Anaesthesiol Scand 1986;30:630–2.CrossRefPubMedGoogle Scholar
  54. 54.
    Atlee JL, Bosnjak ZJ. Mechanisms for cardiac dysrhythmias during anesthesia. Anesthesiology 1990;72:347.CrossRefPubMedGoogle Scholar
  55. 55.
    Waxman MB, Wald RW, Cameron D. Interaction between the autonomic nervous system and tachycardias in Main Cardiology Clinics 1983 Vol 1, No 2 p 143–184.Google Scholar
  56. 56.
    Burn JH, Vaughan-Williams EM, Walker JM. Effects of acetyl-choline in heart lung preparation including production of auricular fibrillation. J Physiol (London) 1953; 128:277–293.Google Scholar
  57. 57.
    Loomis TA, Krop S. Auricular fibrillation induced and maintained by acetylcholine or vagal stimulation. Circ Res 1955;3:390–396.PubMedGoogle Scholar
  58. 58.
    Higgnis CB, Vatner SF, Braunwald E. Parasympathetic control of the heart. Pharmacol Rev 1973;25:119–155.Google Scholar
  59. 59.
    Coumel P, Attuel P, Lavallee Flammang D. Syndrome d’arrhythmie aruriculaire d’origine vagal. Arch Mal Coeur 1978;71:645–658.PubMedGoogle Scholar
  60. 60.
    Alessi R, Nusynowitz M, Abdilskov JA. Non-uniform distribution of vagal effects on the atrial refractory period. Am J Physiol 1958; 194:406–410.PubMedGoogle Scholar
  61. 61.
    Bertolet BD, Hill JA, Kerensky RA, Belardinelli L. Myocardial infarction related atrial fibrillation: role of endogenous adenosine. Heart 1997; 78: 88–90.PubMedGoogle Scholar
  62. 62.
    Krumbhaar EB. Note on electrocardiographic changes following acutely increase pressure following pulmonary artery ligature. AM J Med Sci 1934, Vol clxxxvi(127) 792–794 quoted in Massie.CrossRefGoogle Scholar
  63. 63.
    Lindgren L, Lepantalo M, Von Knorring J, Rosenberg P, Orko R, Scheinin B. Effect of verapamil on right ventricular pressure and atrial tachyarrhythmia after thoracotomy. Br J Anaesth 1991;66:205–11.CrossRefPubMedGoogle Scholar
  64. 64.
    Ritchie AJ, Tolan M, Whiteside M, et al. Prophylactic digitalization fails to control dysrhythmia in thoracic surgical operations. Ann Thorac Surg 1993; 55:86–88.CrossRefPubMedGoogle Scholar
  65. 65.
    Little AG. invited comment on Van Mieghem W et al. Verapamil as prophylactic treatment for atrial fibrillation after lung operations. Ann Thorac Surg 1996; 61: 1086.Google Scholar
  66. 66.
    Phillips E. Delayed Cardiac arrhythmias following pneumonectomy. Ann West Med & Surg 1951; 778–781.Google Scholar
  67. 67.
    von Knorring J, Lepantalo M, Hietanen H, Peder M. Predicting of postoperative cardiac events using ambulatory ECG monitoring prior to abdominal aortic surgery. Eur J Vasc Endovasc Surg 1995; 9:133–7.CrossRefGoogle Scholar
  68. 68.
    Kahn RL, Hargett MJ, Urquhart B, Sharrock NE, Peterson MG. Supraventricular tachyarrhythmias during total joint arthroplasty. Incidence and risk. Clin Orthop 1993; (296):265–9.PubMedGoogle Scholar
  69. 69.
    Allo MD, Thompson NW. Rationale for the operative management of substernal goiters. Surgery 1983; 94:969–77.PubMedGoogle Scholar
  70. 70.
    Ramsey-Stewart G. The perioperative management of morbidly obese patients (a surgeon’s perspective). Anaesth Intensive Care 1985; 13:399–406.PubMedGoogle Scholar
  71. 71.
    Sand J, Marmela K, Airo I, Nordback I. Staging of abdominal cancer by local anesthesia outpatient laparoscopy. Hepato-Gastroenterology 1996;43(12):1685–8.PubMedGoogle Scholar
  72. 72.
    Parikh S, Cohen JR. Perioperative stroke after general surgical procedures. N Y State J Med 1993; 93:162–5.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Dhiraj D. Narula
    • 1
  • Jonathan S. Steinberg
    • 1
  1. 1.St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and SurgeonsNew York

Personalised recommendations