Abstract
Simple SummaryAtrial fibrillation that occurs after surgery raises further questions with respect to spontaneous atrial fibrillation, being an event unquestionably related to the surgical act itself and always quite self-limiting. The purpose of this review is to present the knowledge gained so far, including the most recent findings, regarding this peculiar form of arrhythmia. Its prognostic impact and the possibility of predicting and preventing it were the subject of our analysis, as well as the similarities and differences with spontaneous atrial fibrillation in relation to anticoagulation. Where possible, the search for evidence has focused on studies involving lung cancer patients undergoing thoracic surgery, highlighting any differences with cardiac surgery.Atrial fibrillation (AF) is a common complication of the early postoperative period of various types of surgery, including that for lung cancer. Although induced by the homeostatic alterations related to surgery, there is evidence that it is not a mere stand-alone transitory event, but it represents a relevant complication of surgery, bearing considerable prognostic consequences. Different methods have therefore been explored to predict the occurrence of postoperative atrial fibrillation (POAF) and prevent it. In particular, the age among clinical factors, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as a marker, have proven to be good predictors, and the use of beta-blockers or amiodarone in primary prevention seems to reduce its incidence significantly. There is growing evidence that POAF significantly increases the risk of stroke and global mortality in the long term; therefore, it should be managed in the same way as spontaneous atrial fibrillation. In this review, we will present the strongest evidence found so far and the most recent findings regarding the management of POAF, with a special focus on patients undergoing thoracic surgery for lung cancer.
Highlights
Introduction iationsAtrial fibrillation (AF) has a high incidence in cancer patients
Since in a in large trial, metometoprolol for prophylaxis was associated with an increased ofin death in nonprolol givengiven for prophylaxis was associated with an increased risk of risk death non-cardiac surgery patients, the preventive use of beta-blockers in this specific group of patients is not recommended, while it remains indicated for patients undergoing cardiac surgery in order to reduce postoperative atrial fibrillation (POAF) incidence
POAF is a frequent complication of surgery, including thoracic surgery for lung cancer
Summary
Depending on the type of surgery, POAF complicates between 20 and 40% of cardiac. 20% of POAF non-cardiac operations [4]. 20% of POAF non-cardiac operations [4]. Most cases occur between the 2nd and 4th (10–15%), high for pneumonectomies (>20%). Most cases occur between the 2nd and 4th postoperative (PO) day [6] (Figure 1). Ivanovic et al showed that 23.3% of patients undergoing non-cardiac thoracic surgery. Ivanovic et al showed that 23.3% of patients undergoing non-cardiac thoracic develop POAF within the first 24 h. The peak of incidence occurs approximately at PO surgery develop POAF within the first 24 h. The peak of incidence occurs approximately day 2.5, while by the 3rd PO day, 60% of the episodes of the total recorded had already at PO day 2.5, while by the 3rd PO day, 60% of the episodes of the total recorded had occurred. In a study by Higuchi et al, about 80% of the patients experiencing POAF had no symptoms [8].
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