title: Atrial fibrillation after esophagectomy: an indicator of postoperative morbidity.
abstract: OBJECTIVE
  The relevance of new-onset atrial fibrillation (AF) after esophagectomy remains poorly defined. This study's primary goal is to better define the incidence, clinical patterns, and outcomes associated with the development of AF after esophagectomy.
  
  
  METHODS
  The study is a retrospective review of patients undergoing esophagectomy at a single academic center between May 1996 and December 2007. Patients with new-onset AF were evaluated by univariate and multivariate analyses for risk factors associated with AF onset and outcomes.
  
  
  RESULTS
  New-onset AF was noted in 32 of 156 (20.5%) patients after esophagectomy. Most (16/32, 50%) developed AF within 48 h, and 28 of 32 (87.5%) developed new AF within 72 h of surgery. Pulmonary complications were more frequent in patients with AF than those without AF (59.4% vs. 15.3%, P < 0.01) and usually immediately preceded or occurred concurrently with AF. Anastomotic leaks were significantly more common in patients with AF than those without (28.1% vs. 6.45%, P < 0.01) and were identified, on average, 4.2 days after the onset of AF. In the multivariate analysis, anastomotic leaks, pulmonary complications, and number of complications were significantly associated with AF. Although 60-day survival was worse for patients developing AF (P < 0.01), multivariate analysis suggests that non-AF complications were the independent predictor of mortality.
  
  
  CONCLUSIONS
  New-onset AF after esophagectomy is associated with anastomotic leaks, pulmonary complications, and decreased 60-day survival. Although pulmonary complications typically occurred coincident with the onset of AF, anastomotic leaks were usually diagnosed 4 days after AF onset. New postesophagectomy AF should prompt vigilance for the presence of other concurrent complications.
authors.affiliation: Department of Surgery, The Ohio State University Medical Center, 395 W. 12th Avenue, Suite 634 C, Columbus, OH 43210, USA. stanislaw.stawicki@osumc.edu
authors.forename: Stanislaw P A
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Mark P
authors.initials: MP
authors.lastname: Prosciak
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: H Tracy
authors.initials: HT
authors.lastname: Davido
authors.forename: David E
authors.initials: DE
authors.lastname: Lindsey
authors.forename: Mary E
authors.initials: ME
authors.lastname: Dillhoff
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009820:Ohio / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends