Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy Journal Article
| Authors: | Park, B. J.; Zhang, H.; Rusch, V. W.; Amar, D. |
| Article Title: | Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy |
| Abstract: | Objective: The objective was to define the incidence of atrial fibrillation after video-assisted thoracic surgery lobectomy and determine whether video-assisted thoracic surgery reduces atrial fibrillation rate compared with thoracotomy. Methods: With the use of a single-institution database of patients who underwent lobectomy for clinical stage I non-small cell lung cancer, 389 patients were identified who were in sinus rhythm preoperatively and received no prophylactic antiarrhythmics. Patients undergoing video-assisted thoracic surgery were age and gender matched with those undergoing thoracotomy. Results: After matching, 122 patients undergoing video-assisted thoracic surgery and 122 patients undergoing thoracotomy were eligible for analysis. Patients undergoing video-assisted thoracic surgery had a higher preoperative diffusion capacity (92% ± 28% vs 80% ± 18% predicted, P = .001) and a lower rate of induction chemotherapy (5/122, 4% vs 11/122, 11%, P = .05) than patients undergoing thoracotomy. Atrial fibrillation occurred in 12% of patients (15/122) undergoing video-assisted thoracic surgery and 16% of patients (20/122) undergoing thoracotomy (P = .36). Overall, complications were lower in the video-assisted thoracic surgery group (17.2% vs 27.9%, P = .046). Patients with atrial fibrillation were older in both video-assisted thoracic surgery (73 ± 7 years vs 66 ± 9 years, P = .002) and thoracotomy groups (72 ± 7 years vs 66 ± 10 years, P = .005). Length of stay for patients with atrial fibrillation was greater in both video-assisted thoracic surgery (6.0 ± 1.5 days vs 4.7 ± 2.5 days, P = .01) and thoracotomy groups (9.2 ± 4.3 days vs 6.8 ± 3.6 days, P = .03). Conclusions: Regardless of surgical approach, atrial fibrillation after lobectomy occurred with equal frequency. This supports the theory that autonomic denervation and stress-mediated neurohumoral mechanisms are responsible for the pathogenesis of postoperative atrial fibrillation. Prophylaxis regimens against atrial fibrillation should be the same for either operative approach. © 2007 The American Association for Thoracic Surgery. |
| Keywords: | adult; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; surgical technique; major clinical study; preoperative evaluation; lung lobectomy; lung non small cell cancer; thoracotomy; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; incidence; surgical approach; videorecording; postoperative complication; length of stay; severity of illness index; early cancer; probability; endoscopic surgery; intermethod comparison; age distribution; thorax surgery; thoracic surgery, video-assisted; electrocardiography; heart atrium fibrillation; atrial fibrillation; sex distribution; lung diffusion capacity; sinus rhythm |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 133 |
| Issue: | 3 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2007-03-01 |
| Start Page: | 775 |
| End Page: | 779 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2006.09.022 |
| PUBMED: | 17320583 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 31" - "Export Date: 17 November 2011" - "CODEN: JTCSA" - "Source: Scopus" |
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