Atrial Fibrillation After Resection (AFAR): A PROGRESS III STUDY.

Lee, M J; Hawkins, D J; Bradburn, M J; Lee, J; Brown, S R; Wilson, M J

BACKGROUND Atrial fibrillation (AF) is a common cardiac arrhythmia, and is associated with worsening quality of life and complications such as stroke. Previous work showed that 8% of patients develop new onset AF following colonic resection, and highlighted factors that might predict the development of postoperative AF. The development of a new arrhythmia may have a negative effect on longer term quality of life, as well as cancer survivorship. The aim of this study is to accurately quantify the incidence of AF following colorectal cancer surgery and to validate a model to predict its development. METHODS The AFAR study will recruit 720 patients aged 65 or over undergoing colorectal cancer resection with curative intent. The primary outcome is development of AF within 90 days of surgery. Assessment of cardiac rhythm will be performed using 24-hour "Holter" monitors at baseline, 30, and 90 days post surgery. An ECG will be performed on the day of discharge. Baseline descriptors including model variables and quality of life will be recorded using EQ-5D-5L. The occurrence of complications and other key surgical outcomes will be recorded. An additional blood test for N Terminal pro-BNP (NT-proBNP) will be performed prior to surgery. Statistical analysis will validate a previously derived model and will test the incremental value of added variables such as NT-proBNP. Finally, an exploratory analysis will assess whether changes in ECG measures between baseline and post-operative ECG can predict subsequent new onset AF. DISCUSSION This study will provide data that may allow us to stratify the risk of developing AF following colorectal cancer surgery. This may inform screening or prophylactic approaches.