Postoperative atrial fibrillation in pneumonectomy for primary lung cancer

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.