Clinical and echocardiographic predictors of postoperative atrial fibrillation in lung surgery: the role of left atrial remodelling

Postoperative atrial fibrillation (PoAF) complicates 10-15% of pulmonary lobectomy and 20-30% of pneumonectomy, contributing to increased morbidity, extended hospital stays, and healthcare costs. Identifying predictors of PoAF may aid in risk stratification and preventive care. We prospectively studied 100 consecutive patients who underwent lung surgery for a malignant tumour, including video-assisted thoracic surgery (VATS) and open thoracotomy. Patients with prior atrial fibrillation, cardiac surgery, or thyroid abnormalities were excluded. All patients received pre-operative echocardiography, including speckle-tracking for left atrial (LA) and ventricular function. PoAF incidence was monitored through continuous electrocardiographic follow-up. Univariable and multivariable analyses identified clinical and echocardiographic predictors of PoAF. At univariable analysis, PoAF patients (8%) were more likely to have hypertension (100% vs. 58%, p = 0.018), higher fibrinogen (432 ± 118 mg/dl vs. 346 ± 87 mg/dl, p = 0.03), and lower magnesium levels (1.8 ± 0.2 mEq/l vs. 2.1 ± 0.2 mEq/l, p = 0.003). Echocardiographic differences included larger LA diameter (42 ± 5 mm vs. 35 ± 5 mm, p = 0.002), area (23.8 ± 3.3 cm² vs. 17.7 ± 4.5 cm², p < 0.001), and volume (36.9 ± 7.2 ml vs. 28.6 ± 9.4 ml, p = 0.003). Multivariable analysis identified fibrinogen (HR 1.01, p = 0.036), interventricular septal thickness (HR 3.05, p = 0.029), LA area (HR 1.33, p = 0.016) and LA peak contraction strain (PACS, HR 2.3, p = 0.023) as independent PoAF predictors. Hypertension, inflammation, electrolyte imbalance, and LA remodelling were associated with PoAF. Pre-operative identification of these factors may help target high-risk patients for preventive interventions.