Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy.
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.
Park
Bernard J
BJ
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. parkb@mskcc.org
Zhang
Hao
H
Rusch
Valerie W
VW
Amar
David
D
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011336:Probability; D011379:Prognosis; D012720:Severity of Illness Index; D017678:Sex Distribution; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome