Postoperative outcome of patients undergoing lung resection presenting with new-onset atrial fibrillation managed by amiodarone or diltiazem

OBJECTIVE: Atrial fibrillation (AF) is a common complication after thoracic surgery. The objective of the study was to prospectively evaluate the postoperative outcome of patients undergoing lung resection and presenting with new onset of AF. The postoperative course of AF was also evaluated in relation to either amiodarone or diltiazem employed as anti-arrhythmic agents. METHODS: A prospective observational study during a 3-year period was designed to evaluate all patients presenting AF as a complication of anatomic lung resections. The absence of a history of heart rhythm disease was an inclusion criterion. Amiodarone was employed as the anti-arrhythmic drug during the first 18 months, and diltiazem in the second half of the study. Anti-arrhythmic drugs were started intravenously; when rhythm was restored or after 48h of treatment, they were administered orally. AF duration, recurrences and the postoperative outcome of patients were recorded. RESULTS: Thirty patients fulfilled inclusion criteria. No deaths occurred; median hospital stay was 10 days (range 6-37). AF presented as a solitary complication in 17 patients; in 10 patients it was associated with a respiratory complication and in the last three patients in one case each with pulmonary embolism, acute renal failure and chylothorax respectively. AF occurred on median post-operative day 2 (range: 1-9). Sinus rhythm restoration within the first 24h was observed in 11 (70%) out of the 15 patients receiving diltiazem and in 10 (67%) out of the 15 receiving amiodarone. After 48h, in 80% of patients in both groups cardioversion was achieved. AF recurrence occurred in 11 patients (37%). In 10 out of these 11 patients iterative intravenous treatment was attempted and in all a permanent cardioversion was achieved. Fisher's exact test indicated AF recurrence as being significantly correlated to the presence of a respiratory complication (p=0.02). CONCLUSION: Postoperative outcome of patients undergoing lung surgery with new onset of AF resulted as being significantly complicated by AF recurrence in the case of an associated respiratory complication. The pharmacological strategies tested during this pilot study led to no differences in the postoperative course of AF.