ReviewJournal of cardiothoracic surgery2026
A case of new onset of atrial fibrillation during thoracoscopic lobectomy and review of the literature.
Review in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAtrial fibrillation (AF) is a prevalent perioperative complication associated with lung surgery, contributing to an elevated risk of adverse postoperative outcomes. However, instances of new-onset intraoperative Atrial fibrillation (IOAF) remain infrequently documented. In this report, we present a case of intraoperative new-onset atrial fibrillation occurring during thoracoscopic partial lung resection. Additionally, we examine the risk factors, preventive strategies, and therapeutic interventions for atrial fibrillation, with the objective of enhancing prevention and management of this condition in the perioperative setting. CASE PRESENTATION: A 71-year-old female patient was scheduled to undergo a thoracoscopic left upper lobectomy due to a 'left upper lung mass.' Preoperative electrocardiogram showed occasional atrial premature beats, and cardiac ultrasound indicated left ventricular diastolic dysfunction. During the intraoperative dissection of the hilar lymph nodes, the patient suddenly developed rapid atrial fibrillation with a heart rate of 113 beats per minute, accompanied by pulse deficit. Immediately suspend the surgical operation, but after intravenous administration of dexmedetomidine, the patient's rhythm did not convert to sinus rhythm, and hemodynamic instability occurred. After stabilizing blood pressure with vasoactive drugs, intravenous amiodarone was given to control the ventricular rate. The patient was transferred to the ICU postoperatively and successfully restored sinus rhythm after subsequent amiodarone treatment.
conclusionsNew-onset atrial fibrillation during surgery is a complication that requires attention in thoracic surgery. The novelty of this report lies in: (1)providing a detailed description of the negative clinical experience in which dexmedetomidine was ineffective in this scenario and led to hemodynamic instability, contrasting with previous case reports; (2) proposing a pragmatic strategy of controlling heart rate during surgery and delaying cardioversion until after surgery; (3)emphasizing that elderly women, left lung lobe resection (involving hilar lymph node dissection), and preoperative diastolic dysfunction should also be considered as potential risk factors.
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