Invited commentary

Abstract

Atrial fibrillation (AF) remains the most common arrhythmia after cardiac and major noncardiac thoracic surgery. Postoperative AF is associated with a greater risk of stroke, longer hospitalization, and increased costs. Therefore, preventing postoperative AF would be a significant benefit to patients.In the current study by Amar and colleagues [1Amar D. Goenka A. Zhang H. Park B. Thaler H.T. Leukocytosis and increased risk of atrial fibrillation after general thoracic surgery.Ann Thorac Surg. 2006; 82: 1057-1062Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar], the authors found that in patients undergoing major noncardiac thoracic surgery, a 2-fold increase in white blood cell count (WBC) from preoperative to postoperative day 1 corresponded to a 4.1-fold increase in the odds of developing AF, and for each 10-year increase in age, a corresponding 1.8-fold increase in the risk of AF. The authors believe that postoperative AF results from stress induced by surgery rather than from a systemic inflammatory response. The relationship of postoperative leukocytosis and AF is intriguing, and if confirmed by a larger, prospective series, it may be a useful marker to identify patients who are at increased risk for having this arrhythmia develop.The cause of AF still needs to be determined. Is there one final common pathway that leads to AF? Are there other more specific and accurate markers that may predict when AF is likely to occur so prophylactic treatment can be initiated? Finally, better drugs with fewer side effects need to be developed so that prophylactic treatment of AF can be more effective.The authors are to be congratulated on an interesting article. Atrial fibrillation (AF) remains the most common arrhythmia after cardiac and major noncardiac thoracic surgery. Postoperative AF is associated with a greater risk of stroke, longer hospitalization, and increased costs. Therefore, preventing postoperative AF would be a significant benefit to patients. In the current study by Amar and colleagues [1Amar D. Goenka A. Zhang H. Park B. Thaler H.T. Leukocytosis and increased risk of atrial fibrillation after general thoracic surgery.Ann Thorac Surg. 2006; 82: 1057-1062Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar], the authors found that in patients undergoing major noncardiac thoracic surgery, a 2-fold increase in white blood cell count (WBC) from preoperative to postoperative day 1 corresponded to a 4.1-fold increase in the odds of developing AF, and for each 10-year increase in age, a corresponding 1.8-fold increase in the risk of AF. The authors believe that postoperative AF results from stress induced by surgery rather than from a systemic inflammatory response. The relationship of postoperative leukocytosis and AF is intriguing, and if confirmed by a larger, prospective series, it may be a useful marker to identify patients who are at increased risk for having this arrhythmia develop. The cause of AF still needs to be determined. Is there one final common pathway that leads to AF? Are there other more specific and accurate markers that may predict when AF is likely to occur so prophylactic treatment can be initiated? Finally, better drugs with fewer side effects need to be developed so that prophylactic treatment of AF can be more effective. The authors are to be congratulated on an interesting article. Leukocytosis and Increased Risk of Atrial Fibrillation After General Thoracic SurgeryThe Annals of Thoracic SurgeryVol. 82Issue 3PreviewIn older patients who are known to be at greater risk for atrial fibrillation, we aimed to determine whether patients who develop atrial fibrillation-flutter (AF) after major thoracic surgery have an exaggerated white blood cell (WBC) count in response to surgical stress compared with those who do not develop AF. Full-Text PDF