Incidence and impact of postoperative atrial fibrillation after minimally invasive esophagectomy

Abstract

Atrial fibrillation (AF) following open esophagectomy has been associated with increased rates of pulmonary and anastomotic complications, and mortality. This study seeks to evaluate effects of AF after minimally invasive esophagectomy (MIE). A retrospective review of patients consecutively treated with MIE for esophageal carcinoma, dysplasia. and benign disease from November 2006 to November 2011 was performed. One hundred twenty-one patients underwent MIE. Median age was 65 years (range 26-88) with 85% being male. Thirty-eight (31.4%) patients developed AF postoperatively. Of these 38 patients, 7 (18.4%) had known AF preoperatively. Patients with postoperative AF were significantly older than those without postoperative AF (68.7 vs. 62.8 years, P = 0.008) and more likely to be male (94.7% vs. 80.7%, P = 0.04). Neoadjuvant chemoradiation showed a trend toward increased risk of AF (73.7% vs 56.6%, P = 0.07). Sixty-day mortality was 2 of 38 (5.3%) in patients with AF and 4 of 83 (6.0%) in the no AF cohort (P = 1.00). The group with AF had increased length of hospitalization (13.4 days vs. 10.6 days P = 0.02). No significant differences in rates of pneumonia (31.6% vs. 21.7% P = 0.24), stricture (13.2% vs. 26.5% P = 0.10), or leak requiring return to operating room (13.2% vs. 8.4% P = 0.51) were noted between groups. We did not find an increased rate of AF in our MIE cohort compared with prior reported rates in open esophagectomy populations. AF did result in an increased length of stay but was not a predictor of other short-term morbidities including anastomotic leak, pulmonary complications, stenosis, or 60-day mortality.

Impact of atrial arrhythmias after esophagectomy on recovery

“…Hence, the disease itself might not play a vital part in triggering AAs after esophagectomy. According to studies, [ 6 , 7 , 8 , 10 ] the effect that chemotherapy had on PAAs didn’t reach statistical significance, made the chemotherapy not likely to be the potential iatrogenic cause of AAs after esophagectomy, which was contrary to previous article. [ 17 ] Published researches had demonstrated the link between PAAs and the inflammation which were brought by tissue damage.…”

“…4 ). After eliminating the Day et al study [ 7 ] to focus strictly on new onset PAAs, 5 studies [ 6 , 8 – 11 ] including 1117 patients examined hospital LOS and found that patients with new onset PAAs had longer hospital LOS (MD: 1.37 [95% CI: 0.13–2.62] days, P = .03, I 2 = 45%). Four studies [ 6 , 8 , 9 , 11 ] targeting solely on AF, revealed that patients with postoperative AF had longer hospital LOS (MD: 1.23 [95% CI: 0.05–2.41]days, P = .04, I 2 = 47%).…”

“…7 ). Eliminating the Day et al study [ 7 ] to focus on new onset AF after esophagectomy, revealed that patients with new onset postoperative AF had increased incidence of pulmonary pneumonia (OR 2.71 [95% CI: 1.80–4.09], P < .00001, I 2 = 0%) and anastomotic leakage (OR 2.56 [95% CI: 1.38–4.76], P = .003, I 2 = 37%).…”

“…Other than advanced age, the risk factors of PAAs after esophagectomy varied among studies, including history of cardiac disease, [ 2 , 11 ] blood loss, limited intrathoracic dissection, complications with pulmonary disease and surgical sepsis [1] ; other cardiac arrhythmia [5] ; thyroid disfunction, procedure through thoracic [2] ; postoperative hypoxia, history of COPD [11] ; surgical construction with colon conduit [4] ; medication as ccb, [ 7 ] theophylline. [ 9 ] Risk factors such as history of cardiac disease [ 2 , 11 ] and other cardiac arrhythmia [ 6 ] suggested that vulnerable atrial substrate may contribute to the AAs after esophagectomy.…”

“…[ 2 – 11 ] Many authors have conducted research about the impact of PAAs on complications, [ 2 – 9 ] mortality, [ 2 , 3 , 5 – 11 ] and length of stay (LOS) [ 3 , 5 – 11 ] after esophagectomy, but no unanimous conclusion has been reached. Many studies demonstrate that there is an increased incidence of complication, [ 3 – 5 , 9 ] length of hospital stay, [ 3 , 5 , 7 , 10 ] as well as mortality rate [ 2 , 8 – 10 ] in patients with AAs after esophagectomy, while others [ 6 , 11 ] suggest otherwise. We conducted this meta-analysis to decide whether AAs after esophagectomy hamper recovery.…”