Stawicki Stanislaw P A, Prosciak Mark P, Gerlach Anthony T, Bloomston Mark, Davido H Tracy, Lindsey David E, Dillhoff Mary E, Evans David C, Steinberg Steven M, Cook Charles H
Department of Surgery, The Ohio State University Medical Center, 395 W. 12th Avenue, Suite 634 C, Columbus, OH 43210, USA.
Gen Thorac Cardiovasc Surg. 2011 Jun;59(6):399-405. doi: 10.1007/s11748-010-0713-9. Epub 2011 Jun 15.
The relevance of new-onset atrial fibrillation (AF) after esophagectomy remains poorly defined. This study's primary goal is to better define the incidence, clinical patterns, and outcomes associated with the development of AF after esophagectomy.
The study is a retrospective review of patients undergoing esophagectomy at a single academic center between May 1996 and December 2007. Patients with new-onset AF were evaluated by univariate and multivariate analyses for risk factors associated with AF onset and outcomes.
New-onset AF was noted in 32 of 156 (20.5%) patients after esophagectomy. Most (16/32, 50%) developed AF within 48 h, and 28 of 32 (87.5%) developed new AF within 72 h of surgery. Pulmonary complications were more frequent in patients with AF than those without AF (59.4% vs. 15.3%, P < 0.01) and usually immediately preceded or occurred concurrently with AF. Anastomotic leaks were significantly more common in patients with AF than those without (28.1% vs. 6.45%, P < 0.01) and were identified, on average, 4.2 days after the onset of AF. In the multivariate analysis, anastomotic leaks, pulmonary complications, and number of complications were significantly associated with AF. Although 60-day survival was worse for patients developing AF (P < 0.01), multivariate analysis suggests that non-AF complications were the independent predictor of mortality.
New-onset AF after esophagectomy is associated with anastomotic leaks, pulmonary complications, and decreased 60-day survival. Although pulmonary complications typically occurred coincident with the onset of AF, anastomotic leaks were usually diagnosed 4 days after AF onset. New postesophagectomy AF should prompt vigilance for the presence of other concurrent complications.
食管癌切除术后新发房颤（AF）的相关性仍未明确界定。本研究的主要目标是更好地明确食管癌切除术后房颤发生的发生率、临床模式及相关结局。
本研究是对1996年5月至2007年12月在单一学术中心接受食管癌切除术的患者进行的回顾性分析。对新发房颤患者进行单因素和多因素分析，以确定与房颤发生及结局相关的危险因素。
156例患者中有32例（20.5%）在食管癌切除术后出现新发房颤。大多数（16/32，50%）在48小时内发生房颤，32例中有28例（87.5%）在术后72小时内出现新发房颤。房颤患者的肺部并发症比无房颤患者更常见（59.4%对15.3%，P<0.01），且通常在房颤之前或同时立即发生。房颤患者吻合口漏的发生率显著高于无房颤患者（28.1%对6.45%，P<0.01），平均在房颤发作后4.2天被发现。多因素分析显示，吻合口漏、肺部并发症和并发症数量与房颤显著相关。虽然发生房颤的患者60天生存率较差（P<0.01），但多因素分析表明非房颤并发症是死亡率的独立预测因素。
食管癌切除术后新发房颤与吻合口漏、肺部并发症及60天生存率降低有关。虽然肺部并发症通常与房颤发作同时发生，但吻合口漏通常在房颤发作后4天被诊断出来。食管癌切除术后新发房颤应促使警惕其他并发并发症的存在。
