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Ann Thorac Surg 2006;82:1061-1062
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

Invited commentary

Division of Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225

(Email: mduncan{at}heart.thi.tmc.edu).

Atrial fibrillation (AF) remains the most common arrhythmia after cardiac and major noncardiac thoracic surgery. Postoperative AF is associated with a greater risk of stroke, longer hospitalization, and increased costs. Therefore, preventing postoperative AF would be a significant benefit to patients.

In the current study by Amar and colleagues [1], the authors found that in patients undergoing major noncardiac thoracic surgery, a 2-fold increase in white blood cell count (WBC) from preoperative to postoperative day 1 corresponded to a 4.1-fold increase in the odds of developing AF, and for each 10-year increase in age, a corresponding 1.8-fold increase in the risk of AF. The authors believe that postoperative AF results from stress induced by surgery rather than from a systemic inflammatory response. The relationship of postoperative leukocytosis and AF is intriguing, and if confirmed by a larger, prospective series, it may be a useful marker to identify patients who are at increased risk for having this arrhythmia develop.

The cause of AF still needs to be determined. Is there one final common pathway that leads to AF? Are there other more specific and accurate markers that may predict when AF is likely to occur so prophylactic treatment can be initiated? Finally, better drugs with fewer side effects need to be developed so that prophylactic treatment of AF can be more effective.

The authors are to be congratulated on an interesting article.

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1. Amar D, Goenka A, Zhang H, Park B, Thaler HT. Leukocytosis and increased risk of atrial fibrillation after general thoracic surgery Ann Thorac Surg 2006;82:1057-1062.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): J. Michael Duncan Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Duncan, J. M. Search for Related Content PubMed PubMed Citation Articles by Duncan, J. M. Related Collections Electrophysiology - arrhythmias Related Article