Transthoracic approach is associated with increased incidence of atrial fibrillation after esophageal resection

Abstract

Transthoracic approach is an independent risk factor for the development of new-onset AF after esophagectomy. New-onset AF is associated with severe post-operative complications and longer hospital stay. Minimally invasive approach does not decrease the incidence of new-onset AF.

Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer

“…In the present study, the incidence of postoesophagectomy AF in the placebo group was 30 per cent, similar to previous reports. Mechanisms of AF after oesophagectomy remain unclear, although it may be partially explained by surgical trauma to the cardiac fibres of the sympathetic and parasympathetic nerves.…”

“…Other studies have shown that postoperative AF is associated with other severe complications such as anastomotic leaks and pulmonary complications after oesophagectomy. Whether a leak contributes to the onset of AF or the haemodynamic consequences of AF increase the likelihood of a leak is a subject of debate, and one of the aims of the present study was to see whether the prevention of new‐onset AF would lead to a reduction in other postoperative complications.…”

“…Oesophagectomy for cancer is high‐risk surgery with considerable morbidity and mortality. New‐onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9–46 per cent. This new‐onset AF may be associated with complications, directly by increasing the risks of embolic events and ischaemic events, and indirectly by increasing complications through haemodynamic instability and organ hypoperfusion.…”

“…New-onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9-46 per cent 2 -8 . This new-onset AF may be associated with complications 2,3,8 , directly by increasing the risks of embolic events and ischaemic events, and indirectly by increasing complications through haemodynamic instability and organ hypoperfusion. In this way, AF may be associated with respiratory complications, anastomotic leak and severe infection 2 .…”

Pathophysiology of cancer therapy-provoked atrial fibrillation

“…Following a lung lobectomy, atrial KCNE1 (potassium channel subunit) down-regulation was identified, which suggested an increased outward current in atrial myocytes, shortened atrial action potentials, and enhanced susceptibility to POAF [50]. Furthermore, a strong relationship was observed between postoperative hypoxia and AF after surgery for esophageal carcinoma [51]. Ma et al hypothesized that factors predisposing one to postoperative hypoxia (like COPD) could play a role in the development of AF [49].…”