Postoperative atrial fibrillation (AF) is a common complication following video-assisted thoracoscopic surgery (VATS) and may recur after the initial episode. In this retrospective single-center analysis published in the Heart, Lung, and Circulation, investigators evaluated recurrence rates and perioperative risk factors for paroxysmal postoperative AF in patients undergoing VATS between June 2013 and December 2022.

Among 2,920 patients undergoing VATS, 122 (4.2%) developed paroxysmal postoperative AF within 30 days of surgery. Within one year of the initial episode, 26 of 122 patients (21.3%) experienced AF recurrence. Multivariable logistic regression identified left atrial diameter (odds ratio [OR] 1.13; 95% CI 1.01–1.27; p=0.040), left ventricular ejection fraction (OR 0.91; 95% CI 0.83–0.98; p=0.013), and intraoperative hypotension (OR 5.04; 95% CI 1.20–21.69; p=0.025) as independent factors associated with AF recurrence.

These findings suggest that structural cardiac parameters and intraoperative hemodynamic instability may be associated with recurrent postoperative AF.

Approximately one in five patients with paroxysmal postoperative AF experienced recurrence within one year. Identification of higher-risk individuals may support closer postoperative monitoring.