Thorac Cardiovasc Surg 2013; 61(04): 357-364
DOI: 10.1055/s-0032-1311545
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Atrial Arrhythmias after Pulmonary Resection: The Important Role of Pulmonary Vein Resection

Shenhai Wei
1   Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing, P. R. China
,
Youbin Cui
2   Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, P. R. China
,
Mian Xie
3   Department of Medical Oncology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, P. R. China
,
Guoqin Wang
4   Department on Community-Based Perinatal and Emergency Medicine, Kitasato Clinical Research Center, School of Medicine, Kitasato University, Kanagawa, Japan
,
Yasushi Kyutoku
5   Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
,
Jintao Tian
1   Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing, P. R. China
,
Xiaoping Song
1   Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing, P. R. China
,
Yan Chen
1   Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing, P. R. China
› Author Affiliations
Further Information

Publication History

13 December 2011

11 January 2012

Publication Date:
13 July 2012 (online)

Abstract

Background Atrial arrhythmias (AAs) remain one of the most common complications after pulmonary resection. The association between postoperative AAs and pulmonary vein (PV) resection has not previously been clearly elucidated. A retrospective study on this issue is reported.

Methods A total of 125 patients were involved in this study and all the performed surgical procedures and all postoperative AAs were carefully reviewed and recorded. A univariate and multivariate analyses were utilized to clarify the effect of PV resection on postoperative AAs.

Results The overall incidence of postoperative AAs was 14.4% (n = 18). A stepwise increase in the incidence of AAs was observed from none, to the inferior of PV resection only, superior PV resection only and up to both inferior and superior PV resection (0, 3.1, 14.3, and 38.5%, respectively; p = 0.000). During multivariate analysis, PV resection was identified as an independent risk factor for postoperative AAs when it was entered either as an ordinal or as a categorical variable. The area under the receiver operating characteristic curve of PV resection revealed 0.786 (95% confidence interval [CI], 0.685–0.887), which was significantly larger than the extent of pulmonary resection (0.724; 95% CI, 0.637–0.800; p = 0.015).

Conclusion PV resection plays an important role in the development of postoperative AAs after pulmonary resection and could be used as a good predictor for postoperative AAs.

 
  • References

  • 1 Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg 1993; 106 (6) 1104-1110
  • 2 Foroulis CN, Kotoulas C, Lachanas H, Lazopoulos G, Konstantinou M, Lioulias AG. Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies. Eur J Cardiothorac Surg 2003; 23 (3) 384-389
  • 3 Groban L, Dolinski SY, Zvara DA, Oaks T. Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias. J Cardiothorac Vasc Anesth 2000; 14 (6) 662-665
  • 4 Roselli EE, Murthy SC, Rice TW , et al. Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg 2005; 130 (2) 438-444
  • 5 Tisdale JE, Wroblewski HA, Wall DS , et al. A randomized trial evaluating amiodarone for prevention of atrial fibrillation after pulmonary resection. Ann Thorac Surg 2009; 88: 886-893 ; discussion 894–885
  • 6 Sedrakyan A, Treasure T, Browne J, Krumholz H, Sharpin C, van der Meulen J. Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: evidence from randomized clinical trials. J Thorac Cardiovasc Surg 2005; 129 (5) 997-1005
  • 7 Bradley D, Creswell LL, Hogue Jr CW, Epstein AE, Prystowsky EN, Daoud EG. American College of Chest Physicians. Pharmacologic prophylaxis: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005; 128 (2, Suppl) 39S-47S
  • 8 Onaitis M, D'Amico T, Zhao Y, O'Brien S, Harpole D. Risk factors for atrial fibrillation after lung cancer surgery: analysis of the Society of Thoracic Surgeons general thoracic surgery database. Ann Thorac Surg 2010; 90 (2) 368-374
  • 9 Paul S, Altorki NK, Sheng S , et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010; 139 (2) 366-378
  • 10 Rena O, Papalia E, Oliaro A , et al. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg 2001; 20 (4) 688-693
  • 11 Vaporciyan AA, Correa AM, Rice DC , et al. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg 2004; 127 (3) 779-786
  • 12 Haïssaguerre M, Jaïs P, Shah DC , et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339 (10) 659-666
  • 13 Kistler PM, Sanders P, Fynn SP , et al. Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: acute and long-term outcomes of radiofrequency ablation. Circulation 2003; 108 (16) 1968-1975
  • 14 Lesh MD, Van Hare GF, Epstein LM , et al. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation 1994; 89 (3) 1074-1089
  • 15 Moe GK. A conceptual model of atrial fibrillation. J Electrocardiol 1968; 1 (2) 145-146
  • 16 Tang CW, Scheinman MM, Van Hare GF , et al. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol 1995; 26 (5) 1315-1324
  • 17 Krowka MJ, Pairolero PC, Trastek VF, Payne WS, Bernatz PE. Cardiac dysrhythmia following pneumonectomy. Clinical correlates and prognostic significance. Chest 1987; 91 (4) 490-495
  • 18 Passman RS, Gingold DS, Amar D , et al. Prediction rule for atrial fibrillation after major noncardiac thoracic surgery. Ann Thorac Surg 2005; 79 (5) 1698-1703
  • 19 Nathan H, Eliakim M. The junction between the left atrium and the pulmonary veins. An anatomic study of human hearts. Circulation 1966; 34 (3) 412-422
  • 20 Perez-Lugones A, McMahon JT, Ratliff NB , et al. Evidence of specialized conduction cells in human pulmonary veins of patients with atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14 (8) 803-809
  • 21 Cheung DW. Electrical activity of the pulmonary vein and its interaction with the right atrium in the guinea-pig. J Physiol 1981; 314: 445-456
  • 22 Weerasooriya R, Jaïs P, Scavée C , et al. Dissociated pulmonary vein arrhythmia: incidence and characteristics. J Cardiovasc Electrophysiol 2003; 14 (11) 1173-1179
  • 23 Natale A, Pisano E, Shewchik J , et al. First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation 2000; 102 (16) 1879-1882
  • 24 Roux N, Havet E, Mertl P. The myocardial sleeves of the pulmonary veins: potential implications for atrial fibrillation. Surg Radiol Anat 2004; 26 (4) 285-289
  • 25 Wnuk-Wojnar AM, Trusz-Gluza M, Czerwinski C , et al. Circumferential pulmonary vein RF ablation in the treatment of atrial fibrillation: 3-year experience of one centre. Kardiologia polska 2005; 63: 362-370 ; discussion 371–362
  • 26 Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology 2002; 96 (2) 352-356
  • 27 Olshansky B, Heller EN, Mitchell LB , et al. Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. J Am Coll Cardiol 2005; 45 (12) 2026-2033
  • 28 Efremidis M, Alexanian IP, Oikonomou D , et al. Predictors of atrial fibrillation recurrence in patients with long-lasting atrial fibrillation. Can J Cardiol 2009; 25 (4) e119-e124