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Atrial fibrillation prophylaxis and esophageal resection - our experience

Background and Goal of Study: Atrial fibrillation (FA) is a common complication in major thoracic surgery including esophageal resection. Recent guidelines suggest pharmacological prophylaxis of FA in thoracic surgery. The goal of this study is to find out is there a difference in FA incidence before and after introducing diltiazem FA prophylaxis. Materials and methods: For this study we collected data (age, sex, comorbidity, FA prophylaxis, incidence of FA, the highest observed ventricular answer in FA, ASA status) for patients before the introducing the diltiazem prophylaxis and after it. Only patients with radical esophageal resection are included in the study. We got three groups of patients: one with no prophylaxis, one with diltiazem prophylaxis and one with perioperative continued preoperative antiarrhythmic therapy (beta blocker, amiodarone). The collected data were analyzed. Results and discussion: There were 82 esophageal resections conducted in our Clinics for thoracic surgery “Jordanovac”, University Hospital Centre Zagreb, between November 2012 and May 2015. Postoperative FA is counted in 11 cases (13, 41%). 23 patient received diltiazem FA prophylaxis, 16 patients continued their preoperative beta-antagonist therapy, one patients continued preoperative amiodarone therapy and 42 patients did not receive any FA prophylaxis. Among the patients with postoperative FA, 4 patients were from the group received no FA prophylaxis, 4 patients were form the group received beta blockers, and 3 patients received diltiazem as FA prophylaxis. If we correlate patients with prophylaxis with diltiazem and patients with no FA prophylaxis, we get no significant difference (The Chi-square statistic is 0.1916. The P value is 0.661598. This result is not significant at p <0.05).The highest noticed ventricular answer to FA was 140/min (110-140, median 130) in patients with diltiazem prophylaxis and 180/min (130-180, median 159) with no prophylaxis. Conclusion(s): It seems that the diltiazem prophylaxis does not protect from FA, but we can speculate that it could make FA less deleterious by slowing the ventricular rhythm. To determine the significance of these findings further studies and bigger sample are needed. Reference: Frendel G et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgery procedures. The J Thorac Cardiovasc Surg. 2014 ; 148.3:153-19

atrial fibrillation; prophylaxis; esophageal resection

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