Atrial Fibrillation After Anatomic Lung Resection: Amiodarone Prophylaxis and Risk Stratification
*Eleah Porter1, *Kayla Fay1, *Emlyn Diakow2, *Timothy Millington1, *David Finley1, *Joseph Phillips1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine, Lebanon, NH
Objective: Post-operative atrial fibrillation (POAF) is a known complication that occurs in ~16% after anatomic lung resection. Currently, no formal recommendations exist for prophylaxis. In this study, we identify trends in outcomes and preoperative risk factors at a single center that implemented a protocol of amiodarone prophylaxis.
Design: Retrospective chart review.
Setting: Single tertiary referral center.
Patients: All patients who underwent anatomic lung resection from January 2015 through April 2017.
Interventions: Those ≥ 65 years of age, or at the discretion of the Attending Surgeon, were selected to receive a post-operative amiodarone bolus 300mg IV over 1hour followed by 400mg PO TID x 3 days.
Main Outcome Measures: Post-operative atrial fibrillation within 30 days.
Results: A total of 227 patients underwent anatomic lung resection and 27 (11.9%) experienced POAF. Over 80% were ≥ 65 (n=22) and of those, 86% had received amiodarone. Of the 5 patients <65 who developed POAF, none received amiodarone. Compared to published reports of POAF, our number needed to treat was 25. In our study, those who developed POAF were more likely to be older (71.1 vs 65.0, p=0.001), have a history of Afib (p=0.019), have undergone a lower lobe lung resection (p=0.002), and/or have had an open procedure (p=0.037). POAF significantly increased the post-operative length of stay (6.8 vs 4.4 days, p=0.004).
Conclusions: Post-operative atrial fibrillation continues to be a challenging problem after anatomic lung resection. Our data suggest that POAF is more common in older patients, those with a history of a-fib, patients undergoing a lower lobe resection, and those having an open procedure. Our study also reveals that Amiodarone prophylaxis can result in a risk reduction of 4%.
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