New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer Incidence, Management, and Impact on Short- and Long-term Outcomes

Objective: To study new-onset postoperative atrial fibrillation in patients with esophageal and junctional cancer. Design: Retrospective cohort study from a prospective data base. Background: Atrial fibrillation (AF) is common after thoracic and esophageal surgical procedures. The full spectrum of risk factors, associations, and implications are unclear. Methods: All patients undergoing multimodal therapy or surgery with curative intent from 2006 to mid-2013 were studied. New-onset AF was recorded prospectively. Risk factors, management and resolution, association with other complications, and impact on in-hospital mortality and longer-term oncologic outcomes were analyzed in retrospective cohort analysis. Results: A total of 473 patients (mean age: 63 years; 73% male) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy. Ninety-six (20%) patients developed new-onset AF, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively (P = 0.05). Age, diabetes, neoadjuvant therapy, and cardiac history predisposed (P < 0.05) to AF, and AF was significantly (P < 0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein (CRP) (P < 0.05) but not with anastomotic leak/conduit necrosis or mortality. Amiodarone was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge. At a median follow-up of 40 months (7-109 months), the median survival was 40 months versus 53 months in the AF and non-AF cohorts, respectively (P = 0.353) Conclusions: New-onset AF is common, linked to age, diabetes, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation. For most, it resolves, with no impact on oncologic outcomes.