Postoperative atrial fibrillation in pneumonectomy for primary lung cancer

Abstract

Background: This study assessed the incidence and risk factors (RFs) of postoperative atrial fibrillation (POAF) and its impact on clinical outcomes in patients undergoing pneumonectomy for lung cancer.

Methods: Between 2013 and 2018, this monocentric retrospective study enrolled 324 consecutive pneumonectomy patients for primary lung cancer from our institution and 350 lobectomy and 349 segmentectomy cases matched by age, sex and body mass index (BMI). RF for POAF and postoperative death in pneumonectomy patients were assessed by logistic regression, and long-term outcomes after a median follow-up of 30 (range, 2-61) months by Cox proportional hazard model. Electrophysiology study (EPS) files of 30 AF patients with lung resection history were reviewed.

Results: POAF developed more often after pneumonectomy than lobectomy and segmentectomy (23.2% vs. 6.6% vs. 1.4%, respectively; P<0.001). Among 75 pneumonectomy patients with POAF, POAF was solitary in 55 patients (73.3%) and concurrent with other complications in 3 patients (4%). POAF risk after pneumonectomy was 4 and 22 times that after lobectomy and segmentectomy, respectively, with age >60 years and left atrial diameter (LAd) ≥35 mm as independent predictors. POAF, infection and hemorrhage were independent RFs for perioperative death after pneumonectomy; however, POAF was not RF for long-term death. Pulmonary vein (PV) trigger was identified in 60% (18/30) of AF patients with lung resection history, with stump PVs being more active than non-stump PVs (38.2% vs. 10.5%, P<0.001).

Conclusions: Post-pneumonectomy AF, with remarkable incidence, risk and independent predictors including age >60 years and LAd ≥35 mm, was mostly solitary and possibly secondary to stump and non-stump PV triggers. POAF, along with infection and hemorrhage, was a RF for perioperative death.

Keywords: Postoperative atrial fibrillation (POAF); lobectomy; pneumonectomy; primary lung cancer; segmentectomy.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform (available at http://dx.doi.org/10.21037/jtd-20-1717). LZ reports grants from the National Natural Science Foundation of China, grants from Shenkang Hospital Development Center, during the conduct of the study. The other authors have no conflicts of interest to declare.

2021 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1

Risk ratio of POAF after lung resection according to variables in univariate logistic regression model. A P

Figure 2

Risk ratio of POAF after lung resection in patients overall and pneumonectomy group according to variables in multivariate logistic regression model. A P

Figure 3

Examples of electrophysiological study files of AF patients with lung resection history. (A) Three-dimensional electroanatomic map of a patient with right-superior lobectomy history in CARTO system of left atria in the posterior-anterior view; (B) AF onset set off by PV trigger from stump PV (right-inferior PV), recorded by a circular mapping catheter (Lasso) in the stump, which was indicated by PV potential (red arrow) preceding atrial potential (turquoise arrow) at AF onset; (C) sinus rhythm was restored right after left PV (non-stump PV) isolation in a patient with left-superior lobectomy history. Turquoise arrow indicated atrial fibrillation recorded by CS catheter; red arrow indicated PV isolation completion; (D) after right PV isolation (non-stump PV), active PV potential recorded by a circular mapping catheter placed within right-superior PV and simultaneous sinus rhythm recorded by CS catheter, indicating that AF originated from right-superior PV. Lasso indicates PV potential recorded by a circular mapping catheter. AF, atrial fibrillation; PV, pulmonary vein; CS, coronary sinus; ABLd, distal ablation catheter potential; ABLp, proximal ablation catheter potential.

Figure 4

Kaplan-Meier survival curve showing post-discharge survival of patients who underwent pneumonectomy, lobectomy or segmentectomy, with 95% CI (shaded area). CI, confidence interval.