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Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy.
J Thorac Cardiovasc Surg. 2007 Mar; 133(3):775-9.JT

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.

Authors+Show Affiliations

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. parkb@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17320583

Citation

Park, Bernard J., et al. "Video-assisted Thoracic Surgery Does Not Reduce the Incidence of Postoperative Atrial Fibrillation After Pulmonary Lobectomy." The Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 3, 2007, pp. 775-9.
Park BJ, Zhang H, Rusch VW, et al. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007;133(3):775-9.
Park, B. J., Zhang, H., Rusch, V. W., & Amar, D. (2007). Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. The Journal of Thoracic and Cardiovascular Surgery, 133(3), 775-9.
Park BJ, et al. Video-assisted Thoracic Surgery Does Not Reduce the Incidence of Postoperative Atrial Fibrillation After Pulmonary Lobectomy. J Thorac Cardiovasc Surg. 2007;133(3):775-9. PubMed PMID: 17320583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. AU - Park,Bernard J, AU - Zhang,Hao, AU - Rusch,Valerie W, AU - Amar,David, PY - 2006/07/18/received PY - 2006/09/19/revised PY - 2006/09/29/accepted PY - 2007/2/27/pubmed PY - 2007/3/29/medline PY - 2007/2/27/entrez SP - 775 EP - 9 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 133 IS - 3 N2 - 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/17320583/Video_assisted_thoracic_surgery_does_not_reduce_the_incidence_of_postoperative_atrial_fibrillation_after_pulmonary_lobectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)01752-1 DB - PRIME DP - Unbound Medicine ER -