Diltiazem Does Not Prevent Post-Operative Atrial Fibrillation in Patients Undergoing Thoracoscopic Lobectomy
Madeline Lederer1, Alexa Deemer1, Franzes Liongson1, Nicholas Roma1, Charles Lee2, Jill Stoltzfus2, William Burfeind2.
1Lewis Katz School of Medicine - St. Luke's Hospital, Bethlehem, PA, USA, 2St. Lukes University Hospital, Bethlehem, PA, USA.
OBJECTIVE: Thoracoscopic lobectomy is associated with lower rates of adverse events compared to thoracotomy. Despite this, post-operative atrial fibrillation (POAF) occurs in at least 10% of patients. Our objective is to determine if prophylaxis with diltiazem significantly reduced POAF events.
METHODS: Patients without prior history of atrial fibrillation who underwent thoracoscopic lobectomy from 2007 to 2016 at one institution were analyzed in a retrospective cohort study utilizing a prospective database. Patients treated from 2007 to 2012 received no prophylaxis. Patients treated after 2012 received diltiazem post-operatively. All patients were monitored with continuous telemetry postoperatively. Multivariate direct logistic regression was performed to determine independent predictors of POAF. We report adjusted odds ratios and accompanying 95% confidence intervals, with p<.05 denoting statistical significance.
RESULTS: The final model included 416 patients (52 with POAF, 364 without). Table 1 summarizes group characteristics. In univariate analysis, variables BMI (p= .75); CHF (p= .75); DM (p= .22); HTN (p= .63); and prophylaxis status (p= .41) did not meet inclusion criteria in our multivariate model. Age (p= .02); gender (p= .02); CVA/TIA history (p= .11); and vascular disease (p= .16) were included. Only ages 65-74 (p= 0.03) and >75 (p= 0.02), compared to <65, were statistically significant predictors of POAF in multivariate direct logistic regression. Adjusted odds ratios of ages 65-74 and >75 were 2.88 and 2.62, respectively.
CONCLUSIONS: Diltiazem prophylaxis did not significantly reduce POAF incidence following thoracoscopic lobectomy. Further study is warranted since POAF remains an unwanted source of morbidity and cost for lobectomy patients.
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