E. D. Porter2, K. A. Fay1, T. M. Millington1, D. J. Finley1, J. D. Phillips1 1Dartmouth-Hitchcock Medical Center,Department Of Thoracic Surgery,Lebanon, NH, USA 2Dartmouth-Hitchcock Medical Center,Department Of General Surgery,Lebanon, NH, USA
Introduction: Post-operative atrial fibrillation (POAF) is a known complication after anatomic lung resection. Currently, no formal recommendations exist for its prophylaxis nor its management strategies. In this study, we identifiy trends in outcomes and preoperative risk factors at a single center that implemented a protocol of amiodarone prophylaxis after anatomic lung resection.
Methods: Cohort study at a single tertiary referral center. All patients who underwent anatomic lung resection from January 1, 2015 to April 26, 2017 were selected. Those ≥ 65 years of age, or at the discretion of the Attending Surgeon, were assigned to receive a post-operative amiodarone bolus 300mg IV over 1hour followed by 400mg PO TID x 3 days. Patient charts were reviewed for demographics, co-morbidities, and complications.
Results: A total of 227 patients underwent anatomic pulmonary resection and 27 (13.5%) experienced POAF. One hundred and seventeen patients (51.5%) were ≥ 65 years old. Of those 117 patients, 95 (81.2%) received amiodarone prophylaxis post-operatively and 18.8% experienced POAF. Those who developed POAF were more likely to be older (71.1 vs 65.0, p=0.001), have a history of Afib (p=0.019), have undergone a lower lobe lung resection (p=0.002), and/or had an open procedure (p=0.037). POAF significantly increased the post-operative length of stay (6.8 vs 4.4 days, p=0.004).
Conclusion: Post-operative atrial fibrillation continues to be a challenging problem after anatomic lung resection. Further investigation to establish optimal prophylactic medications and to identify high-risk patients for POAF prevention are needed. Our data suggest that POAF is more common in older patients, those with a history of a-fib, patients undergoing a lower lobe resection, and those having an open procedure. Targeted prophylaxis to these groups may be warranted.