Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Abstract

Atrial fibrillation (AF) is a common supraventricular arrhythmia, a recognized risk factor for ischemic stroke, as a potential driver for heart failure (HF). Cancer patients have an increased risk for AF, even not including any cancer-specific treatment, as surgery or chemotherapy. The mechanism is multifactorial, with inflammation and changes in autonomic tone as critical actors. Commonly, AF is a recurrent complication of the post-operative period in cancer surgery (especially thoracic). Recent papers confirmed a significant incidence of post-operative (non-cardiac surgery) AF (PAF), partially mitigated by the use of prophylactic (rate o rhythm control) treatments. A relevant difference, in terms of mean hospitalization time, emerges between patients developing PAF and those who do not, while long term impact remains a matter of debate, due to several potential confounding factors. Besides clinical predictors, structural (i.e., echocardiographic) and bio-humoral findings may help in risk prediction tasks. In this respect, pre-operative natriuretic peptides (NPs) concentrations are nowadays recognized as significant independent predictors of perioperative cardiovascular complications (including PAF), while elevated post-operative levels may further enhance risk stratification. The aim of the present paper is to trace the state of the art in terms of incidence, management, prevention, and outcome of PAF in the field of thoracic surgical oncology.

Keywords: N-terminal-pro-natriuretic peptide; atrial fibrillation; brain natriuretic peptide; cancer; cardiotoxicity; thoracic surgery; thrombosis.

Figure 1

Daily distribution of post-operative atrial fibrillation—Pooled data with permission from [22,30,31], showing cumulative incidence of post-operative atrial fibrillation episodes, according to days after operation.

Figure 2

Graphical depiction of post-operative atrial fibrillation «milieu»—Independent predictors derived from principal studies from literature are in boxes, according to their type. Contributing mechanisms, including electro-physiological ones, are in blue.