Wang Hao, Wang Zhexin, Zhou Mengmeng, Chen Jindong, Yao Feng, Zhao Liang, He Ben
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Thorac Dis. 2021 Feb;13(2):789-802. doi: 10.21037/jtd-20-1717.
This study assessed the incidence and risk factors (RFs) of postoperative atrial fibrillation (POAF) and its impact on clinical outcomes in patients undergoing pneumonectomy for lung cancer.
Between 2013 and 2018, this monocentric retrospective study enrolled 324 consecutive pneumonectomy patients for primary lung cancer from our institution and 350 lobectomy and 349 segmentectomy cases matched by age, sex and body mass index (BMI). RF for POAF and postoperative death in pneumonectomy patients were assessed by logistic regression, and long-term outcomes after a median follow-up of 30 (range, 2-61) months by Cox proportional hazard model. Electrophysiology study (EPS) files of 30 AF patients with lung resection history were reviewed.
POAF developed more often after pneumonectomy than lobectomy and segmentectomy (23.2% 6.6% 1.4%, respectively; P<0.001). Among 75 pneumonectomy patients with POAF, POAF was solitary in 55 patients (73.3%) and concurrent with other complications in 3 patients (4%). POAF risk after pneumonectomy was 4 and 22 times that after lobectomy and segmentectomy, respectively, with age >60 years and left atrial diameter (LAd) ≥35 mm as independent predictors. POAF, infection and hemorrhage were independent RFs for perioperative death after pneumonectomy; however, POAF was not RF for long-term death. Pulmonary vein (PV) trigger was identified in 60% (18/30) of AF patients with lung resection history, with stump PVs being more active than non-stump PVs (38.2% 10.5%, P<0.001).
Post-pneumonectomy AF, with remarkable incidence, risk and independent predictors including age >60 years and LAd ≥35 mm, was mostly solitary and possibly secondary to stump and non-stump PV triggers. POAF, along with infection and hemorrhage, was a RF for perioperative death.
本研究评估了肺癌肺叶切除术后心房颤动（POAF）的发生率、危险因素（RFs）及其对临床结局的影响。
2013年至2018年期间，这项单中心回顾性研究纳入了本机构324例连续接受原发性肺癌肺叶切除术的患者，以及350例肺叶切除术和349例肺段切除术患者，这些患者在年龄、性别和体重指数（BMI）方面进行了匹配。通过逻辑回归评估肺叶切除术患者发生POAF和术后死亡的危险因素，并通过Cox比例风险模型对中位随访30（范围2 - 61）个月后的长期结局进行评估。回顾了30例有肺切除病史的房颤患者的电生理研究（EPS）文件。
肺叶切除术后POAF的发生率高于肺叶切除术和肺段切除术（分别为23.2%、6.6%、1.4%；P<0.001）。在75例发生POAF的肺叶切除术患者中，55例（73.3%）为孤立性POAF，3例（4%）并发其他并发症。肺叶切除术后发生POAF的风险分别是肺叶切除术和肺段切除术后的4倍和22倍，年龄>60岁和左心房直径（LAd）≥35 mm为独立预测因素。POAF、感染和出血是肺叶切除术后围手术期死亡的独立危险因素；然而，POAF不是长期死亡的危险因素。在有肺切除病史的房颤患者中，60%（18/30）发现肺静脉（PV）触发因素，残端PV比非残端PV更活跃（38.2%对10.5%，P<0.001）。
肺叶切除术后房颤发生率高、风险大，独立预测因素包括年龄>60岁和LAd≥35 mm，多为孤立性，可能继发于残端和非残端PV触发因素。POAF与感染和出血一起是围手术期死亡的危险因素。
