Video-assisted thoracoscopic Ivor-Lewis esophagectomy does not reduce the incidence of postoperative atrial fibrillation

The objective here is to determine the incidence of atrial fibrillation after video-assisted thoracoscopic Ivor-Lewis esophagectomy (VATE) and determine whether VATE reduces incidence of atrial fibrillation compared with open Ivor-Lewis esophagectomy (OE). We conducted a retrospective study to identify patients undergoing IvorLewis esophagectomy who were in sinus rhythm preoperatively and received no prophylactic antiarrhythmics before surgery. Patients undergoing VATE were age and gender matched with those undergoing open thoracotomy. After matching, there were 158 patients in each group. Postoperative atrial fibrillation occurred in 12% of patients (15/122) undergoing VATE and 16% of patients (20/122) undergoing thoracotomy. Overall, postoperative complications were similar between the two groups. Patients with atrial fibrillation were older in both VATE and OE groups (P<0.05). Length of stay for patients with atrial fibrillation was greater in both VATE (P<0.05) and OE groups (P<0.05). In summary, atrial fibrillation after Ivor-Lewis esophagectomy occurred with equal frequency between VATE and OE. This may be due to autonomic denervation and stress-mediated neurohumoral mechanisms which are responsible for the pathogenesis of postoperative atrial fibrillation. Prophylaxis regimens against atrial fibrillation should be applied.