Supraventricular arrhythmias are common rhythm disturbances following pulmonary surgery. The overall incidence varies between 3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful clinical course and revert to normal sinus rhythm, usually before patent’s discharge from hospital. Their importance lies in the immediate hemodynamic consequences, the potential for systemic embolization and the consequent long-term need for prophylactic drug administration, and the increased cost of hospitalization. Their incidence is probably related to the magnitude of the performed operative procedure, occurring more frequently after pneumonectomy than after lobectomy. Investigators believe that surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias. This review discusses currently available information about the potential mechanisms and risk factors for these rhythm disturbances. The discussion is in particular focused on the role of postoperative pain and its relation to the autonomic imbalance, in an attempt to avoid or minimize discomfort with proper analgesia utilization. 1. Introduction Variations from the normal rhythm of the heartbeat, encompassing abnormalities of rate, regularity, site of impulse origin, and sequence of activation are well-documented complications following thoracotomies for surgical treatment of intrathoracic pathology [1–10]. Generally, these perioperative arrhythmias are associated with longer hospital stay and higher cost [8]. Although not widely accepted, many authors believe that patients developing persistent or recurrent tachyarrhythmias present a greater mortality and experience more complications than those who maintained normal sinus rhythms after surgery [1–3]. Based on an up-to-date literature review, this paper discusses currently available information about the potential mechanisms and risk factors for the development of these rhythm disturbances. We searched for original articles, review articles, case series or case reports, and editorials using the MEDLINE database (from January 2002 to September 2012) and the Cochrane Central Register of Controlled Trials by combining the terms “thoracotomy,” “pulmonary resection,” “arrhythmia,” “atrial fibrillation,” “heart rate variability,” and
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