Diltiazem Does Not Prevent Postoperative Atrial Fibrillation After Thoracoscopic Lobectomy

Area of Science:

• Cardiothoracic Surgery
• Cardiac Electrophysiology
• Pulmonary Medicine

Background:

• Thoracoscopic lobectomy offers advantages over thoracotomy but postoperative atrial fibrillation (POAF) remains a common complication, affecting at least 10% of patients.
• Identifying effective prophylactic measures for POAF is crucial to reduce patient morbidity and healthcare costs associated with lobectomy procedures.

Purpose of the Study:

• To evaluate the efficacy of diltiazem prophylaxis in reducing the incidence of POAF in patients undergoing thoracoscopic lobectomy.

Main Methods:

• A retrospective cohort study analyzed 416 patients who underwent thoracoscopic lobectomy between 2007 and 2016.
• Patients treated after 2012 received postoperative diltiazem prophylaxis, while earlier patients did not. All patients underwent continuous telemetry monitoring.
• Multivariate logistic regression identified predictors of POAF, with statistical significance set at P < 0.05.

Main Results:

• The study identified advanced age (65-74 and ≥75 years) as statistically significant predictors of POAF, with adjusted odds ratios of 2.88 and 2.62, respectively.
• Prophylaxis status, body mass index, and history of congestive heart failure, diabetes, or hypertension were not significant predictors in the final model.
• Diltiazem prophylaxis did not demonstrate a significant reduction in POAF incidence.

Conclusions:

• Postoperative diltiazem prophylaxis is not effective in preventing POAF after thoracoscopic lobectomy.
• Further investigation is necessary to develop strategies for mitigating POAF, which contributes to significant morbidity and costs in lobectomy patients.