Clinical Research Of The Atrial Fibrillation Complicated With The Esophagectomy

Atrial fibrillation is one of the very common complications afteresophagectomy. It's mobidity is still very high. To identify the risk factorsassociated with the onset of atrial fibrillation after esophagectomy and explore thedevelopment stages of it, we retrospectively analyzed 192 cases of esophagealcarcinoma who got the esophagectomy done in our department from March 2002to March 2005. We divided them into 2 groups according to the onset of atrialfibrillation after the operation. We selected the older age, the pre-operationelectrocardiogram abnormality, pre-operative hypertension, operation method,anastomosis position as the possible risk factors. Then we compared the twogroups'conditions of the risk factors. By using the statistic methods of χ2 test andodds ratio analysis, we analyzed the association and the association intensitybetween the onset of atrial fibrillation after esophagectomy and risk factors. Wealso analyzed the association of atrial fibrillation with the anastomotic leakage andsurgery death.Among the 192 cases, 24 cases had the atrial fibrillation after operation whichthe morbidity was 12.5%. The further statistic analysis about the association andthe association intensity between the onset of atrial fibrillation afteresophagectomy and risk factors revealed that: 1, older age, especially older than60-year old, was a risk factor associated with the atrial fibrillation afteresophagectomy and the association intensity was strong. 2, The pre-operationelectrocardiogram abnormality and the pre-operative hypertension were both riskfactors associated with the atrial fibrillation after esophagectomy and theassociation intensity were also strong. In the analysis of these two risk factors, inorder to avoid the affluence of the age, we used the stratifiedχ2 test and odds ratioanalysis by divided the two groups into two stratums according to whether the agewas over 60 or not. 3, The operation method and the anastomosis position were notassociated with the atrial fibrillation after esophagectomy. We conclude that olderage, pre-operation electrocardiogram abnormality and pre-operative hypertensionwere risk factors associated with the atrial fibrillation after esophagectomy and theassociation intensity were strong. This will provide us a criterion to evaluate therisk of the atrial fibrillation after esophagectomy and let us take some prophylaxismethod with the patients which had higher risks. The onset of atrial fibrillationevidently increased the happening possibility of the anastomotic leakage, but notincreased the operation death. When we considered the reasons for the risk factors, we thought that thepatients of older age, pre-operation electrocardiogram abnormality andpre-operative hypertension were more likely to have any functional or fundamentalchanges of the heart, like the ectopic pulse increase, sino-atrial nodus functiondecrease and the changes of the cardiac conduct route. Adding that during thecourse of the esophagectomy, we couldn't avoid the touch of the posterior wall ofthe left atrium and the pulmonary veins. Any stimulates to the ectopic pulse pointsof the pulmonary veins may lead the onset of the atrial fibrillation afteresophagectomy. The onset of atrial fibrillation will lead to the disfunction of theatrium. The cardiac output will decrease by about 1/3. This will increase thehappening possibility of the anastomotic leakage. In the past, the development stages of the atrial fibrillation afteresophagectomy was not very clear. In our study, we found that the atrial fibrillationafter esophagectomy was developed from the atrial ectopic pulse to...