title: Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy.
abstract: OBJECTIVE
  Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
  
  
  METHODS
  Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05.
  
  
  RESULTS
  Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62.
  
  
  CONCLUSIONS
  Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.
authors.affiliation: Department of Thoracic Surgery, Nottingham City Hospital, Nottingham, UK. vinayprao@hotmail.com
authors.forename: Vinay P
authors.initials: VP
authors.lastname: Rao
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Addae-Boateng
authors.forename: Anupama
authors.initials: A
authors.lastname: Barua
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects* / Q000379:methods; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents