Low Embolic Risk from Short Duration Atrial Fibrillation following Anatomic Lung Resection

  • Boxiang Jiang University Hospitals Cleveland Medical Center
  • Philip Linden
  • Alejandro Oliu
  • Christopher Towe
  • Yaron Perry
  • Stephanie Worrell

Abstract

Objectives


There is no consensus regarding the merits of anticoagulation following short duration atrial arrhythmia and anatomic lung resection. We hypothesized that the risk of embolic event following episodes of atrial fibrillation (AF) lasting less than 48 hours is low and even with an elevated CHA2DS2-VASC score should not incur the risk of long-term full dose anticoagulation contrary to recommendations.


Design & Intervention


A retrospective review was performed of a prospectively maintained database of all patients undergoing anatomic lung resection at a single institution from 2014 to 2019. Patients who had new onset post-operative atrial fibrillation (POAF) were queried as to their co-morbidities, the length of arrhythmia, discharge with anticoagulation, and any post-operative embolic events.


Main Outcome Measures


There were 565 patients who underwent anatomic lung resection. 40 patients (7.1%) developed new POAF that lasted a median of one day. In 32 patients (80%), POAF lasted for less than 48 hours. There were 28 males and 12 females, median age of 73 years. These patients underwent segmentectomy (2/40), lobectomy (24/40) and pneumonectomy (14/40). Twenty-nine patients were discharged home without anticoagulation. Median follow-up was 22 month (range 1.3 – 62.8 month). Two patients had embolic events and these two were discharged home without anticoagulation. The overall incidence rate of thromboembolic events was 3.2% per person year.


Conclusions


Our data suggest that the risk of arterial embolic events is low in patients with new, short duration atrial fibrillation post anatomical lung resection. Anticoagulation may not be necessary in these patients and can be given selectively.

Keywords: thoracic surgery, pneumonectomy, postoperative care, atrial fibrillation, anticoagulation

Downloads

Download data is not yet available.

References

1. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019;16(7):417-36.
2. Roselli EE, Murthy SC, Rice TW, Houghtaling PL, Pierce CD, Karchmer DP, et al. Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg. 2005;130(2):438-44.
3. 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):368-74.
4. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-76.
5. Fernando HC, Jaklitsch MT, Walsh GL, Tisdale JE, Bridges CD, Mitchell JD, et al. The Society of Thoracic Surgeons practice guideline on the prophylaxis and management of atrial fibrillation associated with general thoracic surgery: executive summary. Ann Thorac Surg. 2011;92(3):1144-52.
6. Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014;148(3):e153-93.
7. Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study. J Cardiothorac Surg. 2012;7:4.
8. Garner M, Routledge T, King JE, Pilling JE, Veres L, Harrison-Phipps K, et al. New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre. Interact Cardiovasc Thorac Surg. 2017;24(2):260-4.
9. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33(12):1500-10.
10. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857-67.
11. Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011;57(2):173-80.
Statistics
274 Views | 0 Downloads
How to Cite
Jiang, B., P. Linden, A. Oliu, C. Towe, Y. Perry, and S. Worrell. “Low Embolic Risk from Short Duration Atrial Fibrillation Following Anatomic Lung Resection”. International Journal of Drug Regulatory Affairs, Vol. 9, no. 1, Mar. 2021, pp. 72-77, doi:10.22270/ijdra.v9i1.457.