Short- and Long-Term Risks of Atrial Fibrillation in Surgically Treated Lung Cancer Patients: A Korean Nationwide Study.

Abstract

We evaluated short- and long-term risks of atrial fibrillation (AF) in patients undergoing surgery for lung cancer (LCA), stratified by treatment modality and time since surgery. We used the Korean National Health Insurance Service database to analyze 34,519 LCA patients who underwent surgery between 2010 and 2017. We matched them 1:3 with controls from the general population. Competing risk models were used to calculate cause-specific hazard ratios (csHRs) and 95% CIs for AF, adjusted for demographic and clinical factors. Landmark analyses were conducted at 1 year, 3 years, and 5 years after LCA surgery. LCA patients had a higher AF risk than controls (csHR, 1.61; 95% CI, 1.53-1.69), peaking within the first year after diagnosis (csHR, 4.06; 95% CI, 3.61-4.58) and gradually declining thereafter but remaining elevated. Patients receiving chemotherapy exhibited sustained elevations in AF risk at 3 years (csHR, 1.44; 95% CI, 1.26-1.65) and 5 years (csHR, 1.40; 95% CI, 1.18-1.66) after surgery. The risk was heightened in patients receiving both chemotherapy and radiation therapy, with consistently high hazard ratios at 3 years (csHR, 2.28; 95% CI, 1.86-2.8) and 5 years (csHR, 2.16; 95% CI, 1.65-2.84) after surgery. In contrast, the AF risk in patients undergoing surgery alone was similar to that of the control group after 3 years. AF risk in LCA patients varies by treatment modality and time since surgery. Surveillance strategies should be tailored accordingly.