Atrial Arrhythmia Strikes 13% After Lung Cancer Surgery

FORT LAUDERDALE, FLA. — Patients undergoing lung resection for non–small cell lung cancer had a 13% risk for developing a new atrial arrhythmia in a review of nearly 14,000 patients in a nationwide database involving 111 centers.

This rate confirms prior reports that atrial arrhythmias appeared in 10%–20% of patients following major noncardiac thoracic surgery. But the new finding is the first to be based on data from so many centers, and the first to focus on outcomes after a single type of thoracic surgery—lung resection for cancer—Dr. Mark W. Onaitis said at the annual meeting of the Society of Thoracic Surgeons.

The analysis identified four factors that significantly correlated with an increased risk for developing atrial arrhythmia after lung cancer surgery: more extensive resection (pneumonectomy or bilobectomy compared with lobectomy), increased age, male gender, and more advanced disease (clinical stage II or higher).

The new model could be used “to improve prognostic stratification, and for prospective prophylactic trials,” said Dr. Onaitis, a thoracic surgeon at Duke University in Durham, N.C.

Patients who developed a new-onset arrhythmia had significantly increased mortality; a higher incidence of several major morbidities, including pneumonia and stroke; and a significantly longer hospital stay. (See box.) During the 30 days following surgery, mortality was 6% in patients who developed an atrial arrhythmia, compared with 2% in those who did not—a significant difference.

The Society of Thoracic Surgeons General Thoracic Surgery Database for 2002–2008 included more than 14,000 patients who had lung resection for non–small cell lung cancer at 111 participating U.S. centers. Excluding patients with atrial arrhythmia prior to surgery left 13,904 patients, of whom 1,755 (13%) developed atrial arrhythmia during the 30 days following surgery.

Multivariate analysis revealed that pnemonectomy doubled the risk for development of atrial arrhythmia compared with lobectomy, while bilobectomy boosted the risk by 67% compared with single lobectomy. Each 10 years of increased age was linked to an 81% increased risk for arrhythmia, and men had a 60% increased risk compared with women. Patients with nodal disease, clinical stage II or greater, had a 28% increased risk for arrhythmia. The analysis also identified one protective feature: African Americans were 38% less likely to develop arrhythmia than were whites. These parameters together accounted for two-thirds of the variance in the rate of new-onset atrial arrhythmias.

Elsevier Global Medical News

My Take

Dissecting the Problem of Atrial Fibrillation After Lung Resection

Atrial fibrillation is consistently second only to duration of air leak as the major driver for length of stay after pulmonary resection. Because the downstream consequences of atrial fibrillation, such as stroke and other thromboembolic events, are so significant, and because its treatment is costly and associated with its own morbidity, perioperative atrial fibrillation may even exceed prolonged air leak as a health risk.

The relationship between postoperative atrial fibrillation and lung resection has long been explored in general thoracic surgery. For decades, colleagues have reportedly documented the incidence, especially following pneumonectomy, when it can occur in as many as a quarter or third of patients. The search for effective and simple prophylaxis has been difficult, even in the pneumonectomy patients known to be at highest risk. There is simply little convincing, multi-institutional–derived evidence that pharmacologic prophylaxis can reduce the risk.

Dr. Onaitis and his colleagues are to be congratulated for leveraging the STS database to begin to dissect this problem. They confirmed the importance of the problem by finding a threefold increase in 30-day mortality in patients who develop perioperative atrial fibrillation. Their simplified risk model allows physicians to stratify risk and better counsel patients. Unfortunately, the prognostic factors don't provide an opportunity to modify the risk. Perhaps the most beneficial outcome of this work will be to identify patients at highest risk who are the best candidates for pharmacologic prophylaxis in the hope of defining a signal of therapeutic efficacy.

FORT LAUDERDALE, FLA. — Patients undergoing lung resection for non–small cell lung cancer had a 13% risk for developing a new atrial arrhythmia in a review of nearly 14,000 patients in a nationwide database involving 111 centers.

This rate confirms prior reports that atrial arrhythmias appeared in 10%–20% of patients following major noncardiac thoracic surgery. But the new finding is the first to be based on data from so many centers, and the first to focus on outcomes after a single type of thoracic surgery—lung resection for cancer—Dr. Mark W. Onaitis said at the annual meeting of the Society of Thoracic Surgeons.

The analysis identified four factors that significantly correlated with an increased risk for developing atrial arrhythmia after lung cancer surgery: more extensive resection (pneumonectomy or bilobectomy compared with lobectomy), increased age, male gender, and more advanced disease (clinical stage II or higher).

The new model could be used “to improve prognostic stratification, and for prospective prophylactic trials,” said Dr. Onaitis, a thoracic surgeon at Duke University in Durham, N.C.

Patients who developed a new-onset arrhythmia had significantly increased mortality; a higher incidence of several major morbidities, including pneumonia and stroke; and a significantly longer hospital stay. (See box.) During the 30 days following surgery, mortality was 6% in patients who developed an atrial arrhythmia, compared with 2% in those who did not—a significant difference.

The Society of Thoracic Surgeons General Thoracic Surgery Database for 2002–2008 included more than 14,000 patients who had lung resection for non–small cell lung cancer at 111 participating U.S. centers. Excluding patients with atrial arrhythmia prior to surgery left 13,904 patients, of whom 1,755 (13%) developed atrial arrhythmia during the 30 days following surgery.

Multivariate analysis revealed that pnemonectomy doubled the risk for development of atrial arrhythmia compared with lobectomy, while bilobectomy boosted the risk by 67% compared with single lobectomy. Each 10 years of increased age was linked to an 81% increased risk for arrhythmia, and men had a 60% increased risk compared with women. Patients with nodal disease, clinical stage II or greater, had a 28% increased risk for arrhythmia. The analysis also identified one protective feature: African Americans were 38% less likely to develop arrhythmia than were whites. These parameters together accounted for two-thirds of the variance in the rate of new-onset atrial arrhythmias.

Elsevier Global Medical News

My Take

Dissecting the Problem of Atrial Fibrillation After Lung Resection

Atrial fibrillation is consistently second only to duration of air leak as the major driver for length of stay after pulmonary resection. Because the downstream consequences of atrial fibrillation, such as stroke and other thromboembolic events, are so significant, and because its treatment is costly and associated with its own morbidity, perioperative atrial fibrillation may even exceed prolonged air leak as a health risk.

The relationship between postoperative atrial fibrillation and lung resection has long been explored in general thoracic surgery. For decades, colleagues have reportedly documented the incidence, especially following pneumonectomy, when it can occur in as many as a quarter or third of patients. The search for effective and simple prophylaxis has been difficult, even in the pneumonectomy patients known to be at highest risk. There is simply little convincing, multi-institutional–derived evidence that pharmacologic prophylaxis can reduce the risk.

Dr. Onaitis and his colleagues are to be congratulated for leveraging the STS database to begin to dissect this problem. They confirmed the importance of the problem by finding a threefold increase in 30-day mortality in patients who develop perioperative atrial fibrillation. Their simplified risk model allows physicians to stratify risk and better counsel patients. Unfortunately, the prognostic factors don't provide an opportunity to modify the risk. Perhaps the most beneficial outcome of this work will be to identify patients at highest risk who are the best candidates for pharmacologic prophylaxis in the hope of defining a signal of therapeutic efficacy.

FORT LAUDERDALE, FLA. — Patients undergoing lung resection for non–small cell lung cancer had a 13% risk for developing a new atrial arrhythmia in a review of nearly 14,000 patients in a nationwide database involving 111 centers.

This rate confirms prior reports that atrial arrhythmias appeared in 10%–20% of patients following major noncardiac thoracic surgery. But the new finding is the first to be based on data from so many centers, and the first to focus on outcomes after a single type of thoracic surgery—lung resection for cancer—Dr. Mark W. Onaitis said at the annual meeting of the Society of Thoracic Surgeons.

The analysis identified four factors that significantly correlated with an increased risk for developing atrial arrhythmia after lung cancer surgery: more extensive resection (pneumonectomy or bilobectomy compared with lobectomy), increased age, male gender, and more advanced disease (clinical stage II or higher).

The new model could be used “to improve prognostic stratification, and for prospective prophylactic trials,” said Dr. Onaitis, a thoracic surgeon at Duke University in Durham, N.C.

Patients who developed a new-onset arrhythmia had significantly increased mortality; a higher incidence of several major morbidities, including pneumonia and stroke; and a significantly longer hospital stay. (See box.) During the 30 days following surgery, mortality was 6% in patients who developed an atrial arrhythmia, compared with 2% in those who did not—a significant difference.

The Society of Thoracic Surgeons General Thoracic Surgery Database for 2002–2008 included more than 14,000 patients who had lung resection for non–small cell lung cancer at 111 participating U.S. centers. Excluding patients with atrial arrhythmia prior to surgery left 13,904 patients, of whom 1,755 (13%) developed atrial arrhythmia during the 30 days following surgery.

Multivariate analysis revealed that pnemonectomy doubled the risk for development of atrial arrhythmia compared with lobectomy, while bilobectomy boosted the risk by 67% compared with single lobectomy. Each 10 years of increased age was linked to an 81% increased risk for arrhythmia, and men had a 60% increased risk compared with women. Patients with nodal disease, clinical stage II or greater, had a 28% increased risk for arrhythmia. The analysis also identified one protective feature: African Americans were 38% less likely to develop arrhythmia than were whites. These parameters together accounted for two-thirds of the variance in the rate of new-onset atrial arrhythmias.

Elsevier Global Medical News

My Take

Dissecting the Problem of Atrial Fibrillation After Lung Resection

Atrial fibrillation is consistently second only to duration of air leak as the major driver for length of stay after pulmonary resection. Because the downstream consequences of atrial fibrillation, such as stroke and other thromboembolic events, are so significant, and because its treatment is costly and associated with its own morbidity, perioperative atrial fibrillation may even exceed prolonged air leak as a health risk.

The relationship between postoperative atrial fibrillation and lung resection has long been explored in general thoracic surgery. For decades, colleagues have reportedly documented the incidence, especially following pneumonectomy, when it can occur in as many as a quarter or third of patients. The search for effective and simple prophylaxis has been difficult, even in the pneumonectomy patients known to be at highest risk. There is simply little convincing, multi-institutional–derived evidence that pharmacologic prophylaxis can reduce the risk.

Dr. Onaitis and his colleagues are to be congratulated for leveraging the STS database to begin to dissect this problem. They confirmed the importance of the problem by finding a threefold increase in 30-day mortality in patients who develop perioperative atrial fibrillation. Their simplified risk model allows physicians to stratify risk and better counsel patients. Unfortunately, the prognostic factors don't provide an opportunity to modify the risk. Perhaps the most beneficial outcome of this work will be to identify patients at highest risk who are the best candidates for pharmacologic prophylaxis in the hope of defining a signal of therapeutic efficacy.