Con: Atrial Fibrillation Prophylaxis Is Not Necessary in Patients Undergoing Major Thoracic Surgery

Postoperative atrial fibrillation (POAF) is a common complication after thoracic surgery, with an incidence that peaks on postoperative days 2 to 3. 1 Tisdale J.E. Wroblewski H.A. Kesler K.A. Prophylaxis of atrial fibrillation after noncardiac thoracic surgery. Semin Thorac Cardiovasc Surg. 2010; 22: 310-320 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar The incidence of POAF in noncardiac thoracic surgery patients varies considerably among different surgical procedures: 12% to 30% after lobectomy, 23% to 67% after pneumonectomy, and 13% to 46% following esophagectomy. 1 Tisdale J.E. Wroblewski H.A. Kesler K.A. Prophylaxis of atrial fibrillation after noncardiac thoracic surgery. Semin Thorac Cardiovasc Surg. 2010; 22: 310-320 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Despite extensive research on the mechanisms of chronic atrial fibrillation (AF), the mechanisms leading to POAF are not yet elucidated fully. Furthermore, most of the medical literature on POAF stems from cardiac surgical patients and has been extrapolated to other noncardiac thoracic surgical patients. It is therefore difficult to determine how relevant these findings are to the management of this latter patient population.