Incidence, Risk Factors and Clinical Implications of New-onset Postoperative Atrial Fibrillation Following Esophagectomy for Esophageal Cancer

Xiao-wen Wang ¹, Xu-Yang Liu ¹, Cheng Zhang ², Lin-Jun Li ², Chun Huang ¹, Ming Du ¹, Ying-Jiu Jiang ¹, Qing-Chen Wu ¹, Xiao Xie ³, Ju Mei ³

¹ Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; ² Department of Cardiothoracic Surgery Intensive Care Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; ³ Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

Background: New-onset postoperative atrial fibrillation (POAF) is a relatively common complication after thoracic surgery, which is associated with increased morbidity, mortality and hospital length of stay. Thus, the purpose of this study is to determine the incidence, risk factors, and clinical implications of POAF following esophagectomy for patients with esophageal cancer.

Methods: We performed a prospective observational study at our institution between from January 2016 to October 2017. Data prospectively collected from consecutive patients without a history of arrhythmia, who underwent esophagectomy. POAF was defined as any episode of atrial fibrillation lasting longer than 30 min. Univariable and multivariable logistic regression analyses were performed to identify risk factors predicting POAF. Morbidity and 30-days mortality were compared between patients who did and did not develop POAF.

Results: A total of 150 patients were identified (25 minimally invasive and 124 open esophagectomy). Mean age was 63years (range 46-80) with 81.3 % being male. The incidence of POAF was 22% (33/150). Multivariate regression analysis identified significant independent risk factors of POAF were higher body mass index (BMI≥25kg/m²) (odds ratio [OR]:1.38, 95% confidence interval [CI]:2.43, p=0.016), LAD≥35mm (OR: 1.51, 95% CI:2.59, p=0.032), preoperative serum potassium levels＜4mmol/L(OR: 1.44, 95% CI:3.26, p=0.001)，postoperative mechanical ventilation duration≥300min (OR:1.03, 95% CI:1.37, p=0.041). POAF was associated with a higher rate of pneumonia, respiratory failure and anastomotic leaks, longer intensive care unit and hospital lengths of stay. At 30-day follow-up, a total of three patients (2%) had died, with no differences between the POAF (3%) and no-POAF (1.7%) groups, p=0.52.

Conclusions: POAF occurs commonly after esophagectomy for patients with esophageal cancer. POAF is associated with BMI, RAD, preoperative serum potassium levels, and postoperative mechanical ventilation duration. POAF was associated with a higher rate of major morbidity, but not a higher mortality, at 30 days follow-up.