Left atrial size predicts the onset of atrial fibrillation after major pulmonary resections

Atrial fibrillation (AF) is a frequent complication after pulmonary resections. Notwithstanding prevention and early treatment it may show a negative impact on the outcome. We assessed the role of echocardiographic variables to predict the onset of this complication.

One-hundred and thirty-four patients were prospectively evaluated: 72 (53.7%) (Group I) underwent lobectomy or pneumonectomy; 62 (46.3%) receiving minor thoracic procedures were included in Group II. Previous AF was the only exclusion criteria. All patients preoperatively underwent bidimensional echocardiography. Demographics, type of resection, histology, staging, diagnosis of chronic obstructive pulmonary disease , induction chemotherapy, smoking history, magnesium levels, other cardiologic diseases, electrocardiographic and echocardiographic findings (atrial and ventricular diameters, left atrial area, left ventricular ejection fraction and diastolic dysfunction) were assessed.

Preoperative variables did no't show any statistically significant difference between the groups. In 21 patients (15.7%) AF was observed 3.7 ± 1.8 days after surgery. All AF episodes occurred in Group I. Three patients (2.2%) with AF died during the postoperative course. The left atrial diameter and area were significantly enlarged in patients with AF (P = 0.001 and P < 0.0002); 18 AF episodes (86%) occurred in patients with atrial enlargement. At univariate analysis low postoperative magnesium levels, LV diastolic dysfunction, left atrial antero-posterior diameter >40 mm, left atrial area above 20 mm(2) and extended resections were statistically significant. At multivariate analysis only left atrial area enlargement was an independent predictive prognostic factor for postoperative AF.

Echocardiographic left atrial size evaluation may be useful to predict the onset of postoperative AF in patients undergoing lobectomy and pneumonectomy.