Smoking History As A Risk Factor For Atrial Fibrillation Following Robotic-assisted Video-thoracoscopic Pulmonary Lobectomy
Jessica R. Glover1, Samuel B. Reynolds1, Maria F. Echavarria1, Emily P. Ng1, Frank O. Velez-Cubian1, Carla C. Moodie2, Joseph R. Garrett2, Jacques P. Fontaine2, Eric M. Toloza2.
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.
OBJECTIVE: This study sought to determine whether smoking status or pulmonary function of robotic-assisted pulmonary lobectomy patients are risk factors for development of atrial fibrillation (AFib) in the early post-operative period to allow for more targeted dispositioning of post-lobectomy patients.
METHODS: We retrospectively analyzed 353 consecutive patients without history of AFib and who underwent robotic-assisted video-thoracoscopic (RAVTS) lobectomy by one surgeon from September 2010 through August 2016. Patients were analyzed with respect to smoking status, pack-years, months of smoking cessation, and pulmonary function. Chi-Square (X2), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p≤0.05.
RESULTS: In our study, 17 of 144 men (11.8%) and 16 of 209 women (7.7%) experienced new-onset AFib following RAVTS lobectomy (p=0.19). Mean age of our patients who developed AFib was 72.8 years and 66.4 years for those who did not (p<0.001). Former smokers represented 72.7% of new AFib cases, current smokers 21.2%, and never smokers 6.1% (p=0.009). Former smokers were at higher risk than either never (OR 5.30, 95% CI 1.22 to 23.09, p=0.03) or current smokers (OR 2.62, 95% CI 1.09 to 6.31, p=0.03). Former smokers who developed AFib were older (74.6 vs. 69.1 years, p=0.004) and more often diabetic (OR 3.27, 95% CI 1.31 to 8.17, p=0.01). There was no difference in AFib rates for light (≤15 pack-years) versus heavy (>15 pack-years) smokers (p=0.21). Never smokers fared better than light (p=0.02) but not heavy (p=0.13) smokers. There was no difference in pack-years for former versus current smokers who developed AFib (p=0.11). For all groups, development of AFib was independent of pre-operative pulmonary function, as measured by percent of predicted forced expiratory volume in 1 second (FEV1%) or by percent of predicted diffusion capacity of the lung for carbon monoxide (DLCO%) (p=0.09 and p=0.63, respectively), and was also unaffected by the presence of COPD (p=0.80).
CONCLUSIONS: Former and light smokers are at higher risk than both current and never smokers for developing AFib after RAVTS lobectomy, independent of pack-years and pre-operative pulmonary function. Duration of smoking cessation prior to lobectomy does not change the likelihood of developing AFib.
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