Impact of new-onset atrial fibrillation on 12-month outcomes and mortality after esophagectomy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Adults undergoing esophagectomy (n=1977). Intervention: New-onset atrial fibrillation (NOAF) vs. No NOAF. Primary outcome: death within 0-3 months (HR 2.09, 95% CI 1.62-2.70).

Q: What does this research mean for the field?

New-onset atrial fibrillation following esophagectomy is associated with significantly increased risks of 12-month mortality and heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hani Essa; Ashwin Balu; Brian Johnston; Nathan Stephens; Gregory Y H Lip; Ingeborg Welters

doi:10.1093/dote/doag058

May 12, 2026Diseases of the EsophagusOpen Access

Impact of new-onset atrial fibrillation on 12-month outcomes and mortality after esophagectomy

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Key result

New-onset AF after esophagectomy linked to ~109% higher early mortality risk.

HR 2.09
95% CI 1.62-2.70
n=1,977

Figures

Graphical abstract published by Diseases of the Esophagus — Graphical abstract · Published by Diseases of the Esophagus · CC BY

Why the study?

New-onset atrial fibrillation is a frequent complication after esophagectomy linked to adverse short-term outcomes, but its longer-term cardiovascular impact remains uncertain.

Does new-onset atrial fibrillation increase the risk of mortality and cardiovascular complications in adults undergoing esophagectomy?

Key Points

To evaluate the associations between new-onset atrial fibrillation (NOAF) and postoperative complications over 12 months after esophagectomy.
Retrospective cohort study using a large international dataset from TriNetX
Identified adults undergoing esophagectomy, excluding prior atrial fibrillation
Propensity score matching balanced demographics and analyzed outcomes using Cox proportional hazards models.
NOAF associated with higher death risk within 0-3 months (HR 2.09, 95% CI 1.62-2.70)
Increased risk of heart failure persistently observed (HR 2.23, 95% CI 1.56-3.19) across 12 months
NOAF linked to pneumonia, venous thromboembolism, and rehospitalization during the short-term period.

Study Design

Type

Cohort (n=1,977)

Multicenter

Yes

Structured PICO

Does new-onset atrial fibrillation increase the risk of mortality and cardiovascular complications in adults undergoing esophagectomy?

P

Population

1,977 propensity-matched adults undergoing esophagectomy without prior atrial fibrillation, evaluated for outcomes over 12 months.

E

Exposure

New-onset atrial fibrillation (NOAF) within 30 days postoperatively

C

Comparator

No new-onset atrial fibrillation (1:1 propensity score matched for demographics, comorbidities, and medication use)

O

Outcome

Postoperative cardiovascular and respiratory complications (death, heart failure, myocardial infarction, pneumonia, venous thromboembolism, rehospitalization, and stroke) over 12 monthshard clinical

Main Result

Hazard Ratio: 2.09 (95% CI 1.62–2.7)

New-onset atrial fibrillation after esophagectomy is associated with significantly increased risks of mortality and cardiovascular complications, particularly heart failure, up to 12 months postoperatively.

Implication

May warrant closer post-esophagectomy surveillance; leaves open whether NOAF is causal or a marker of severity.

Abstract

New-onset atrial fibrillation (NOAF) is a frequent complication after esophagectomy. While associated with adverse short-term outcomes, its longer-term cardiovascular impact remains uncertain. We evaluated associations between NOAF and postoperative cardiovascular and respiratory complications using a large international real-world dataset. We performed a retrospective cohort study using the TriNetX global federated health research network. Adults undergoing esophagectomy were identified using ICD-10, CPT, and SNOMED codes, excluding those with prior atrial fibrillation or flutter. NOAF was defined within 30 days postoperatively. Propensity score matching (1:1) balanced demographics, comorbidities, and medication use. Outcomes were assessed over 12 months using Cox proportional hazards models. We analyzed 1977 matched patients (mean age 67.1 ± 8.7 years; 18% female). Within 0-3 months, NOAF was associated with increased risks of death (HR 2.09, 95% CI 1.62-2.70), heart failure (HR 2.03, 95% CI 1.32-3.11), myocardial infarction (HR 2.35, 95% CI 1.17-4.74), pneumonia (HR 1.80, 95% CI 1.42-2.29), venous thromboembolism (HR 1.76, 95% CI 1.17-2.66), and rehospitalization (HR 2.78, 95% CI 2.42-3.20), with no significant association for stroke. Between 3 and 12 months, elevated risks persisted for death (HR 1.60, 95% CI 1.30-1.98) and heart failure (HR 2.55, 95% CI 1.37-4.73). Across 12 months, NOAF remained associated with death (HR 1.76, 95% CI 1.50-2.07) and heart failure (HR 2.23, 95% CI 1.56-3.19). NOAF after esophagectomy identifies patients at increased risk of major postoperative and cardiovascular complications, particularly early after surgery.

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Cite This Study

Essa et al. (2026) conducted a cohort in Adults undergoing esophagectomy (n=1,977). New-onset atrial fibrillation (NOAF) vs. No NOAF was evaluated on death within 0-3 months (HR 2.09, 95% CI 1.62-2.70). New-onset atrial fibrillation after esophagectomy was associated with an increased risk of death within 0-3 months (HR 2.09; 95% CI 1.62-2.70) and across 12 months (HR 1.76; 95% CI 1.50-2.07).

synapsesocial.com/papers/6a3d91bf408ebb922448b0ea https://doi.org/10.1093/dote/doag058