Does the Surgical Approach Affect the Incidence of Postoperative Atrial Fibrillation After Thoracic Surgery? A Systematic Review and Meta-analysis

Overview

Journal Updates Surg

Specialty General Surgery

Date 2025 Mar 14

PMID 40082340

Authors

Debora Brascia

Giuseppe Mangiameli

Veronica Maria Giudici

Emanuela Re Cecconi

Matilde Luppichini

Giuseppe Marulli

Affiliations

Soon will be listed here.

Abstract

Postoperative atrial fibrillation (PAF) is a common complication after lung resection, since surgical stress may act as a trigger. The VATS approach reduces surgical stress and alleviates inflammation and oxidative stress commonly associated with open lung surgery. However, only a few studies have investigated the possible impact of the surgical approach on the incidence of PAF. A literature review was performed through PubMed, EMBASE, and Google Scholar in March 2024, to identify any study published since 2000 evaluating the role of the VATS vs the open approach to perform lung resections as a risk factor for postoperative atrial fibrillation. Pooled odds ratio (OR) estimates with 95% confidence intervals (CIs) were calculated. Twenty-one studies, including 59,101 patients, met the criteria for inclusion. Both propensity-matched and non-matched data showed that VATS was associated with a significant reduction in PAF compared to open thoracotomy (OT) (OR 0.73; 95% CI 0.58-0.91; I2 = 10.1%, p = 0.349). A meta-regression was conducted to explore contributing factors, showing the geographic regions in which the studies were conducted may be a significant source of heterogeneity. Subgroup analyses revealed less heterogeneity in studies conducted in Europe and on those focused solely on lobectomy. Postoperative atrial fibrillation risk following VATS is significantly lower than OT. Further prospective randomized controlled trials with large sample sizes are needed to confirm these findings.

References

Vaporciyan A, Correa A, Rice D, Roth J, Smythe W, Swisher S . Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004; 127(3):779-86. DOI: 10.1016/j.jtcvs.2003.07.011. View

Dyszkiewicz W, Skrzypczak M . Atrial fibrillation after surgery of the lung: clinical analysis of risk factors. Eur J Cardiothorac Surg. 1998; 13(6):625-8. DOI: 10.1016/s1010-7940(98)00084-0. View

Gomez-Caro A, Moradiellos F, Ausin P, Diaz-Hellin V, LARRU E, Perez-Anton J . [Risk factors for atrial fibrillation after thoracic surgery]. Arch Bronconeumol. 2006; 42(1):9-13. DOI: 10.1016/s1579-2129(06)60107-9. View

Allessie M, Boyden P, Camm A, Kleber A, Lab M, Legato M . Pathophysiology and prevention of atrial fibrillation. Circulation. 2001; 103(5):769-77. DOI: 10.1161/01.cir.103.5.769. View

Echahidi N, Pibarot P, OHara G, Mathieu P . Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008; 51(8):793-801. DOI: 10.1016/j.jacc.2007.10.043. View

Amar D, Zhang H, Leung D, Roistacher N, Kadish A . Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002; 96(2):352-6. DOI: 10.1097/00000542-200202000-00021. View

Park B, Zhang H, Rusch V, Amar D . Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007; 133(3):775-9. DOI: 10.1016/j.jtcvs.2006.09.022. View

Crispi V, Isaac E, Abah U, Shackcloth M, Lopez E, Eadington T . Surgical factors associated with new-onset postoperative atrial fibrillation after lung resection: the EPAFT multicentre study. Postgrad Med J. 2020; 98(1157):177-182. DOI: 10.1136/postgradmedj-2020-138904. View

Richardson W, Wilson M, Nishikawa J, Hayward R . The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995; 123(3):A12-3. View

10.

Bland J, Altman D . Statistics notes. The odds ratio. BMJ. 2000; 320(7247):1468. PMC: 1127651. DOI: 10.1136/bmj.320.7247.1468. View

11.

Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109):629-34. PMC: 2127453. DOI: 10.1136/bmj.315.7109.629. View

12.

Harbord R, Egger M, Sterne J . A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2005; 25(20):3443-57. DOI: 10.1002/sim.2380. View

13.

Amar D, Zhang H, Tan K, Piening D, Rusch V, Jones D . A brain natriuretic peptide-based prediction model for atrial fibrillation after thoracic surgery: Development and internal validation. J Thorac Cardiovasc Surg. 2019; 157(6):2493-2499.e1. PMC: 6626556. DOI: 10.1016/j.jtcvs.2019.01.075. View

14.

Berry M, DAmico T, Onaitis M . Use of amiodarone after major lung resection. Ann Thorac Surg. 2014; 98(4):1199-206. PMC: 4409813. DOI: 10.1016/j.athoracsur.2014.05.038. View

15.

Falcoz P, Puyraveau M, Thomas P, Decaluwe H, Hurtgen M, Petersen R . Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg. 2015; 49(2):602-9. DOI: 10.1093/ejcts/ezv154. View

16.

Fong L, Ko V, McLaughlin A, Okiwelu N, Newman M, Passage J . Outcomes of video-assisted thoracoscopic surgery lobectomy in septuagenarians. ANZ J Surg. 2020; 90(5):752-756. DOI: 10.1111/ans.15788. View

17.

Garner M, Routledge T, King J, Pilling J, Veres L, Harrison-Phipps K . New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre. Interact Cardiovasc Thorac Surg. 2016; 24(2):260-264. DOI: 10.1093/icvts/ivw348. View

18.

Halloran S, Martin S, Jiang B, Bassiri A, Sinopoli J, Tapias Vargas L . Risk Factors for Chronic Atrial Fibrillation Following Lung Lobectomy. J Surg Res. 2023; 295:350-356. DOI: 10.1016/j.jss.2023.11.031. View

19.

He G, Yao T, Zhao L, Geng H, Ji Q, Zuo K . Atrial fibrillation and alteration of heart rate variability after video-assisted pulmonary lobectomy versus thoracotomy pulmonary lobectomy. J Cardiothorac Surg. 2020; 15(1):220. PMC: 7427877. DOI: 10.1186/s13019-020-01260-6. View

20.

Ishibashi H, Wakejima R, Asakawa A, Baba S, Nakashima Y, Seto K . Postoperative Atrial Fibrillation in Lung Cancer Lobectomy-Analysis of Risk Factors and Prognosis. World J Surg. 2020; 44(11):3952-3959. DOI: 10.1007/s00268-020-05694-w. View