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Identifying predictors of PoAF may aid in risk stratification and preventive care. We prospectively studied 100 consecutive patients who underwent lung surgery for a malignant tumour, including video-assisted thoracic surgery (VATS) and open thoracotomy. Patients with prior atrial fibrillation, cardiac surgery, or thyroid abnormalities were excluded. All patients received pre-operative echocardiography, including speckle-tracking for left atrial (LA) and ventricular function. PoAF incidence was monitored through continuous electrocardiographic follow-up. Univariable and multivariable analyses identified clinical and echocardiographic predictors of PoAF. At univariable analysis, PoAF patients (8%) were more likely to have hypertension (100% vs. 58%, <jats:italic>p<\/jats:italic>\u2009=\u20090.018), higher fibrinogen (432\u2009\u00b1\u2009118 mg\/dl vs. 346\u2009\u00b1\u200987 mg\/dl, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), and lower magnesium levels (1.8\u2009\u00b1\u20090.2 mEq\/l vs. 2.1\u2009\u00b1\u20090.2 mEq\/l, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Echocardiographic differences included larger LA diameter (42\u2009\u00b1\u20095 mm vs. 35\u2009\u00b1\u20095 mm, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), area (23.8\u2009\u00b1\u20093.3 cm<jats:sup>2<\/jats:sup> vs. 17.7\u2009\u00b1\u20094.5 cm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and volume (36.9\u2009\u00b1\u20097.2 ml vs. 28.6\u2009\u00b1\u20099.4 ml, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Multivariable analysis identified fibrinogen (HR 1.01, <jats:italic>p<\/jats:italic>\u2009=\u20090.036), interventricular septal thickness (HR 3.05, <jats:italic>p<\/jats:italic>\u2009=\u20090.029), LA area (HR 1.33, <jats:italic>p<\/jats:italic>\u2009=\u20090.016) and LA peak contraction strain (PACS, HR 2.3, <jats:italic>p<\/jats:italic>\u2009=\u20090.023) as independent PoAF predictors. Hypertension, inflammation, electrolyte imbalance, and LA remodelling were associated with PoAF. Pre-operative identification of these factors may help target high-risk patients for preventive interventions.<\/jats:p>","DOI":"10.1007\/s11739-025-03930-6","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T21:29:20Z","timestamp":1744147760000},"page":"1097-1106","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and echocardiographic predictors of postoperative atrial fibrillation in lung surgery: the role of left atrial remodelling"],"prefix":"10.1007","volume":"20","author":[{"given":"Valentina","family":"Scheggi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Salvicchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Menale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5155-3022","authenticated-orcid":false,"given":"Jacopo","family":"Giovacchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fumagalli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Santamaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Spanalatte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Marcucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Voltolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Marchionni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"issue":"36","key":"3930_CR1","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","volume":"45","author":"IC Van Gelder","year":"2024","unstructured":"Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, L\u00f8chen ML, Lumbers RT, Maesen B, M\u00f8lgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D, ESC Scientific Document Group (2024) 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). 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The research protocol has been approved by the locally appointed ethics committee (Comitato Etico di Area Vasta Centro, section of Comitato Etico Regionale della Regione Toscana - 21093_oss). The patient provided written informed consent for participation in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights statement and Informed consent"}}]}}