Diltiazem Does Not Prevent Postoperative Atrial Fibrillation After Thoracoscopic Lobectomy

Abstract

Objective Thoracoscopic lobectomy is associated with lower rates of adverse events compared to thoracotomy. Despite this, postoperative atrial fibrillation (POAF) occurs in at least 10% of patients. Our objective is to determine if prophylaxis with diltiazem significantly reduced POAF events. Methods Patients without prior history of atrial fibrillation who underwent thoracoscopic lobectomy from 2007 to 2016 at one institution were analyzed in a retrospective cohort study utilizing a prospective database. Patients treated from 2007 to 2012 received no prophylaxis. Patients treated after 2012 received diltiazem postoperatively. All patients were monitored with continuous telemetry postoperatively. Multivariate direct logistic regression was performed to determine independent predictors of POAF. We report adjusted odds ratios and accompanying 95% confidence intervals, with P < 0.05 denoting statistical significance. Results The final regression model included 416 patients (52 with POAF, 364 without). In univariate analysis, the variables of body mass index and history of congestive heart failure, diabetes, or hypertension, and prophylaxis status did not meet inclusion criteria. Age, gender, history of stroke or transient ischemic attack, and vascular disease were included. Only ages 65 to 74 ( P = 0.03) and ≥75 ( P = 0.02), compared to <65, were statistically significant predictors of POAF. Adjusted odds ratios of ages 65 to 74 and ≥75 were 2.88 and 2.62, respectively. Conclusions Diltiazem prophylaxis did not significantly reduce POAF incidence following thoracoscopic lobectomy. Further study is warranted since POAF remains an unwanted source of morbidity and cost for lobectomy patients.

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management

“…At the same time, its use was associated with several side effects [67]. Lederer et al, in a very recent study, showed that diltiazem prophylaxis was not useful in reducing POAF incidence after thoracoscopic lobectomy [68].…”

Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies

“…In a study conducted by Van Mieghem et al, verapamil demonstrated superiority over placebo in decreasing the incidence of POAF after pulmonary surgery; however, it also induced bradycardia and hypotension in a significant number of patients ( 88 ). Nevertheless, there exist several studies with conflicting outcomes; for instance, diltiazem prophylaxis did not exhibit efficacy in reducing the occurrence of POAF after thoracoscopic lobectomy ( 89 , 90 ). Furthermore, a recent investigation by Hochreiter et al revealed that diltiazem prophylaxis failed to reduce the incidence of POAF after thoracoabdominal esophagectomy and instead led to increased occurrences of bradycardia and norepinephrine requirements ( 91 ).…”