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Name
James King

Thu, 11/18/2021 - 10:36

Hi Kyla,
Thank you for an excellent facilitated discussion and blog post. You did a superb job navigating the class through a difficult topic during the facilitated discussion!
Here, I was hoping to discuss the relationship between surgery type and perioperative AF. As mentioned during the lecture, Dr. Conen stated that there are three types of surgery associated with increased risk of perioperative AF. These surgery types, in order of greatest to least risk, are thoracic surgery, major vascular surgery, and major abdominal surgery. I found this fascinating and made me wonder, why are these types of surgery associated with increased risk and not other forms of major surgery? My initial hypothesis was that these types of surgeries were done on structures located closer to the heart and that might have some relationship to the association stated above. I do think that the severity of the surgery might have some relationship as well. For example, I would not expect a minimally invasive laproscopic surgery to be associated with high rates of AF if this were true. However, this would not account for other types of major surgery, such as neurosurgery, not being listed in this group of non-cardiac surgeries associated with increased risk of perioperative AF. I did find some evidence for this second hypothesis from the realm of surgery for esophageal cancer. Patients that underwent minimally invasive esophagectomy (MIE) were at an 81% reduced risk of postoperative AF compared to those patients that underwent open esophagectomy (1). It has been reported that MIE led to lower rates of postoperative AF and, importantly, short- and long-term survival were not compromised (1,2).
I would love to hear from others regarding their take on the relationship between surgery type and perioperative AF. Has anyone else found any good studies on perioperative AF for other types of surgery?
Best,
James
1. Chen et al., 2020. The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients with preserved left ventricular ejection fraction. World J Surg Oncol. 11.
2. Chen et al., 2020. Impact of minimally invasive esophagectomy in post-operative atrial fibrillation and long-term mortality in patients among esophageal cancer. Cancer Control. 27.

Name
James King

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