COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer

Yasuo Sekine, Kenneth Kesler, Mehrdad Behnia, JoAnn Brooks-Brunn, Eri Sekine, John Brown

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Abstract

Purpose: This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV1 of ≤ 70% predicted and an FEV1/FVC ratio of ≤ 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis. Results: Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.001). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.003). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.004). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0033 and p = 0.0009, respectively). Conclusion: Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.

Original languageEnglish
Pages (from-to)1783-1790
Number of pages8
JournalChest
Volume120
Issue number6
DOIs
StatePublished - 2001

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Supraventricular Tachycardia
Non-Small Cell Lung Carcinoma
Chronic Obstructive Pulmonary Disease
Cardiac Arrhythmias
Lung
Incidence
Digoxin
Mortality
Pneumonectomy
Respiratory Function Tests
Group Psychotherapy
Atrial Fibrillation
Hospitalization
Multivariate Analysis

Keywords

  • Cardiac arrhythmia
  • COPD
  • Multivariate analysis
  • Non-small cell lung cancer
  • Postoperative cardiac complications
  • Pulmonary resection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. / Sekine, Yasuo; Kesler, Kenneth; Behnia, Mehrdad; Brooks-Brunn, JoAnn; Sekine, Eri; Brown, John.

In: Chest, Vol. 120, No. 6, 2001, p. 1783-1790.

Research output: Contribution to journalArticle

Sekine, Yasuo ; Kesler, Kenneth ; Behnia, Mehrdad ; Brooks-Brunn, JoAnn ; Sekine, Eri ; Brown, John. / COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. In: Chest. 2001 ; Vol. 120, No. 6. pp. 1783-1790.
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abstract = "Purpose: This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV1 of ≤ 70{\%} predicted and an FEV1/FVC ratio of ≤ 70{\%} based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis. Results: Seventy-six patients (31.9{\%}) experienced new onsets of postoperative SVT, with 58 of these patients (76.3{\%}) demonstrating atrial fibrillation. The COPD group had a 58.7{\%} incidence of SVT (n = 44) compared to a 27.0{\%} incidence (n = 44) in the non-COPD group (p < 0.001). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7{\%} vs 37.8{\%}, respectively; p = 0.003). Overall, there were 16 operative deaths (6.6{\%}), and the mortality rate was significantly higher in the COPD group (14.1{\%}) than in the non-COPD group (3.0{\%}; p = 0.004). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0033 and p = 0.0009, respectively). Conclusion: Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.",
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T1 - COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer

AU - Sekine, Yasuo

AU - Kesler, Kenneth

AU - Behnia, Mehrdad

AU - Brooks-Brunn, JoAnn

AU - Sekine, Eri

AU - Brown, John

PY - 2001

Y1 - 2001

N2 - Purpose: This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV1 of ≤ 70% predicted and an FEV1/FVC ratio of ≤ 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis. Results: Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.001). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.003). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.004). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0033 and p = 0.0009, respectively). Conclusion: Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.

AB - Purpose: This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV1 of ≤ 70% predicted and an FEV1/FVC ratio of ≤ 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis. Results: Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.001). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.003). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.004). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0033 and p = 0.0009, respectively). Conclusion: Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.

KW - Cardiac arrhythmia

KW - COPD

KW - Multivariate analysis

KW - Non-small cell lung cancer

KW - Postoperative cardiac complications

KW - Pulmonary resection

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