A review and analysis of strategies for prediction, prevention and management of post-operative atrial fibrillation after non-cardiac thoracic surgery

Atrial fibrillation (AF) is the most commonly sustained arrhythmia after non-cardiac thoracic surgery, occurring after 12–44% of pulmonary and esophageal resections (1). It is associated with a significant increase in post-operative morbidity, length of stay (LOS), intensive care unit (ICU) admission and mortality (1,2). Patients who develop postoperative atrial fibrillation (POAF) often experience an increased LOS of 2 to 14 days (3). If sustained, POAF can increase a patient’s risk of thromboembolic events and it an independent risk factor of stroke in the 30 days following development of new sustained AF (4,5). Therefore, in some cases anticoagulation is critical (5). AF is associated with increased mortality risk after esophagectomy (mortality increase from 4.8% to 8.1%, P=0.04) (6) and decreased long-term survival after lobectomy (HR 3.75; 95% CI, 1.44 to 9.08) (1). As AF is both common and impactful, efforts to effectively and optimally predict, prevent and manage POAF is critical to improving quality of thoracic surgical care