Supraventricular arrhythmias after resection surgery of the lung

Objective: Two hundred consecutive patients undergoing resection surgery of the lung during 1999 were retrospectively reviewed to define prevalence. t ype, clinical course and risk factors for postoperative supraventricular ar rhythmias (SVA) with particular reference to atrial fibrillation or flutter (AF). Methods: Records of 200 lung patients were collected and analysed wi th particular attention to preoperative physiologic values and associated p athologies, lung functional status, electrocardiogram registration, extent of surgical resection of the lung and were also analysed to confirm or excl ude correlation between them and postoperative AF. three patients were excl uded as they were affected preoperatively by SVA. Results: Forty-five episo des of SVA, 41 of AF were identified in 197 patients (22%) and were more pr evalent in several groups of patients such as those with increased age. pne umonectomy and superior lobectomy. Rhythm disturbances were most likely to develop on the second day after surgery. Ninety-eight percent of AF disappe ared within a day of discharge and sinus rhythm was restored with digitalis or other antiarrhythmic drugs in all patients except one who was discharge d with persistent atrial fibrillation. Arrhythmias were not direct causes o f any in-hospital deaths. There is a tendency in the difference of the AF r ate between pneumonectomy and upper lobectomy patients versus inferior lobe ctomy ones, probably related to the different anatomic structure of the pro ximal trunks of the upper and inferior veins of the lung, respectively. Con clusions: Statistical analysis revealed that increased age, extent and type of pulmonary resection. such as pneumonectomy and superior lobectomy were significant risk factors. Despite these factors, arrhythmias after lung sur gery could be managed easily and were not closely related to higher mortali ty. Direct cause of AF after lung resection surgery remains unclear: anatom ical substrate such as surgical damage to the cardiac plexus or to the prox imal trunks of the pulmonary veins covered by myocardial sleeves with elect rical properties are to be considered. (C) 2001 Elsevier Science B.V. All r ights reserved.