Oral Diltiazem Prophylaxis for Atrial Fibrillation in Patients Undergoing Robotic Lobectomy

Atrial fibrillation (AF) prophylaxis with diltiazem has not been studied after robotic lobectomies. We aimed to determine whether prophylaxis with oral diltiazem is associated with a lower rate of AF after robotic lobectomy.

A retrospective review of all robotic lobectomies during an 8-year period was conducted. After our practice protocol change (September 2014), patients undergoing lobectomy were prescribed prophylactic oral diltiazem postoperatively to reduce the incidence of AF. Demographics, operative variables, smoking history, diagnosis, and rate of postoperative AF were collected. Study groups were defined as group 1 (operated before protocol change without postoperative oral diltiazem prophylaxis administered) and group 2 (operated after protocol change and postoperative oral diltiazem prophylaxis administered). Statistical analysis included Student t test, χ² test, and univariate/multivariable and propensity score matching analysis.

After excluding patients with history of AF (n = 48), beta-blocker/calcium-channel blocker use (n = 177), and patients who did not receive diltiazem prophylaxis after protocol change (n = 60), 333 remained for analysis (group 1 [n = 133], group 2 [n =200]). There were no significant differences regarding demographics, smoking status, or operative characteristics. Overall length of stay was similar between groups (P = .2). There was no difference in the rate of postoperative AF (group 1, 7% [9 of 133] vs group 2, 8% [16 of 200]; P = .6). After multivariable analysis, only male sex showed significantly higher odds of postoperative AF (odds ratio, 3.24, 95% CI, 1.18-8.86, P = .02).

Oral diltiazem prophylaxis after robotic lobectomy was not associated with a lower rate of postoperative AF. Its use could be tailored to those at higher risk of postoperative AF to achieve its therapeutic benefit.