Postoperative Atrial Fibrillation Following Anatomic Lung Resection: A Case Report and Narrative Review of Contemporary Pharmacologic Management.

Postoperative atrial fibrillation (POAF) is a common complication following anatomic lung resection, contributing to increased morbidity and mortality, prolonged hospital stays, and higher healthcare costs. Despite its frequency, there remains limited consensus on optimal pharmacologic management in this population, particularly in the context of balancing efficacy with the unique risks associated with thoracic surgery. This report aims to draw attention to the clinical significance of POAF in thoracic surgery, particularly following pulmonary resections, by presenting a representative case and contextualizing it through a focused review of current literature and consensus guidelines. A 77-year-old man developed POAF with rapid ventricular response (RVR) following a uniportal video-assisted thoracoscopic surgery (VATS) right lower lobe (RLL) basilar segmentectomy. The patient's clinical course, therapeutic interventions, and outcomes are discussed in the context of existing guidelines and treatment paradigms. To contextualize the case, we conducted a literature review focused on pharmacologic management strategies for POAF following anatomic lung resection, specifically pulmonary lobectomy. We reviewed PubMed and Scopus databases, applying predefined inclusion and exclusion criteria to identify relevant peer-reviewed articles. Included articles were peer-reviewed studies evaluating pharmacologic treatments for adult patients with new-onset POAF following pulmonary lobectomy. Studies were excluded if they involved only non-lobectomy surgeries, patients with pre-existing atrial fibrillation (AF) or atrial flutter, did not discuss treatment interventions, or included fewer than 10 patients. Our review highlights the evidence supporting commonly used agents such as amiodarone, beta-blockers, calcium channel blockers, and magnesium, with attention to both their prophylactic and therapeutic roles. Consideration is also given to the safety and efficacy of amiodarone in the postoperative thoracic population. This case report underscores the complexity of managing POAF after anatomic lung resection and highlights the need for greater development, recognition, and implementation of evidence-based guidelines driven by data in pulmonary as opposed to solely cardiac populations. While pharmacologic interventions such as amiodarone have demonstrated effectiveness based on the literature review and were well-tolerated in this case, individualized patient risk assessment remains essential.