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Is there a role for prophylaxis against atrial fibrillation for patients undergoing lung surgery?

Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, UK

^* Corresponding author. Address: Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7AZ, UK. Tel.: +44-780-1548-122. (E-mail: joeldunning{at}doctors.org.uk).

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether prophylactic anti-arrhythmic drugs may prevent atrial fibrillation (AF) following lung resection. Altogether 457 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We identified single randomized trials that have demonstrated a benefit for Diltiazem, Bupivacaine epidural and magnesium for prophylaxis against AF in patients undergoing non-cardiac thoracic surgery, with a number needed to treat of between 4 and 8 with these regimes.