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Surgical factors associated with new-onset postoperative atrial fibrillation after lung resection: the EPAFT multicentre study
  1. Vassili Crispi1,2,
  2. Emmanuel Isaac2,
  3. Udo Abah3,
  4. Michael Shackcloth3,
  5. Eileen Lopez4,
  6. Thomas Eadington4,
  7. Marcus Taylor4,
  8. Rammohan Kandadai4,
  9. Neil R Marshall5,
  10. Anil Gurung6,
  11. Luke J Rogers7,
  12. Adrian Marchbank7,
  13. Suhail Qadri2,
  14. Mahmoud Loubani2
  1. 1 Hull York Medical School, University of Hull, Hull, Kingston upon Hull, UK
  2. 2 Department of Thoracic Surgery, Castle Hill Hospital, Cottingham, East Riding of Yorkshire, UK
  3. 3 Department of Thoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  4. 4 Department of Thoracic Surgery, Wythenshawe Hospital, Manchester, UK
  5. 5 Peninsula Medical School, University of Plymouth, Plymouth, Devon, UK
  6. 6 Great Western Hospital Foundation NHS Trust, Swindon, Swindon, UK
  7. 7 Department of Thoracic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
  1. Correspondence to Vassili Crispi, Hull York Medical School, Hull HU6 7RX, UK; Vassili.Crispi{at}


Purpose of the study Postoperative atrial fibrillation (POAF) is a recognised complication in approximately 10% of major lung resections. In order to best target preoperative treatment, this study aimed at determining the association of incidence of POAF in patients undergoing lung resection to surgical and anatomical factors, such as surgical approach, extent of resection and laterality.

Study design Evaluation of Post-operative Atrial Fibrillation in Thoracic surgery (EPAFT): a multicentre, population-based, retrospective, cross-sectional, observational study including 1367 patients undergoing lung resections between April 2016 and March 2017. The primary outcome was the presence of POAF following resection. POAF was defined as at least one episode of symptomatic or asymptomatic AF confirmed by ECG within 7 days from the thoracic procedure or prior to discharge from the hospital.

Results POAF was observed in 7.4% of patients: 3.1% in minor resection (video-assisted thoracoscopic surgery (VATS): 2.5%; thoracotomy: 3.8%), 9.0% in simple lobectomy (VATS: 7.3%, thoracotomy: 9.9%), 6.0% in complex resection (thoracotomy: 6.3%) and 11.4% in pneumonectomy. POAF was higher in left (4.0%) vs right (2.4%) minor resections, and in left (9.9%) vs right (8.3%) lobectomy, but higher in right (7.5%) complex resections, and the highest in right pneumonectomy (17.6%). No significant variations were observed as per sex, laterality or resected lobes. A positive univariable and multivariable association was observed for increasing age and increasing extent of resection, but not thoracotomy. Median (Q1–Q3) hospital stay was 9 (7–14) days in POAF and 5 (4–7) days in non-AF patients (p<0.001), with an increased cerebrovascular accident burden (p<0.001) and long-term mortality (p<0.001).

Conclusions Among patients undergoing lung resection, POAF was significantly associated with age, increasing invasiveness of approach and increasing extent of resection. In addition, POAF carried a significant long-term mortality rate and burden of cerebrovascular accident. Appropriate prophylaxis should be targeted at these groups.

  • anatomy
  • thoracic surgery

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Presented at NIHR Clinical Research Network Yorkshire and Humber Cardiology and Cardiothoracic Surgery Specialty Meeting 2020, Society for Cardiothoracic Surgery (SCTS) Annual Meeting 2020, and European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting 2020

  • Correction notice This article has been corrected since it appeared Online First. Duplicate affiliation has been removed.

  • Contributors VC, EI and ML planned the study. VC recruited the other units. MS, RK, AM and ML coordinated data collection at their local units. VC, UA, EL, TE, MT, NRM, AG and LJR performed the data collection. VC performed data analysis. All authors contributed to the intellectual content and drafting. VC submitted the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.