Left Atrial Diameter as a Predictor of Postoperative Atrial Fibrillation (POAF) Following Lung Resection Surgeries

Background: Many of the chronic resectable pulmonary lesions can lead to chronic pulmonary congestion and cardiac enlargement. POAF is a significant complication that often occurs after resecting these lesions. Objective: In this retrospective observational study, we evaluated whether preoperative left atrial dilation (left atrial diameter LAD > 4 cm) can predict POAF after pulmonary resection surgery. Methods: We recruited 120 patients who underwent elective pulmonary resection surgeries in Cairo, Beniseuf, and Fayoum University Hospitals during the period between January 2022 and June 2025. Patients were subsequently divided into two groups based on the existence of left atrial dilatation, as detected by preoperative transthoracic echocardiography (TTE): group A (standard group; 60 patients) and group B (LAD group; 60 patients). Following surgery, data on the incidence of POAF, hospitalization, and early mortality were gathered and interpreted. Results: In our study group, 32 (26.7%) out of 120 patients had POAF; 23 of these patients were in the LAD group, while the other 9 were in the other group, denoting a statistically significant difference (23 (38.3%) and 9% (15%), P = 0.003). Preoperative dilated left atrium (LAD ≥ 4.0 cm) was found to be an independent predictor of POAF using multivariate logistic regression (adjusted OR: 4.8; 95% CI: 1.8-12.3; p = 0.002). ROC curve analysis produced an AUC of 0.82, indicating that LAD has an excellent discriminatory ability for predicting POAF. Group B exhibited a higher number of patients with prolonged ICU durations (>3 days) and lengthier hospital admissions when contrasted with the non-LAD group (17 vs. 7 patients, p = 0.039) and (14.8 ± 9.13 vs. 11.05 ± 5.2 days, p = 0.017), respectively. Conclusion: Preoperative left atrial dilatation is a significant independent predictor of POAF following lung resection surgeries. LAD assessment by TTE should be considered in the preoperative evaluation to identify high-risk patients and guide prophylactic interventions.