Association between early postoperative coefficient of variation of heart rate and delayed atrial fibrillation following sublobar lung resection: a retrospective cohort study.

Sublobar resection is increasingly established as a standard of care for early-stage non-small cell lung cancer, yet predictors of delayed postoperative atrial fibrillation (POAF) in this specific population remain understudied. This retrospective cohort study utilized the MIMIC-IV database to investigate whether early postoperative coefficient of variation of heart rate (HR-CV) independently predicts delayed POAF (> 24 h) in 348 patients requiring intensive care after wedge resection or segmentectomy. Unlike traditional static risk factors, continuous monitoring data were analyzed to capture dynamic autonomic fluctuations. The incidence of delayed POAF was 16.7%. Multivariable logistic regression demonstrated that elevated HR-CV in the first 24 postoperative hours was significantly associated with delayed POAF (p = 0.003), whereas coefficient of variation of systolic blood pressure (SBP-CV) showed no significant association. Adding HR-CV to a clinical baseline model (age, hypertension, and heart failure) improved the Area Under the Curve (AUC) from 0.690 to 0.722. These findings suggest that autonomic dysregulation, rather than systemic hemodynamic instability, acts as a primary driver of arrhythmia in this cohort. We further developed a web-based risk calculator to facilitate the translation of these physiological signals into bedside risk stratification.