Postoperative atrial fibrillation independently predicts reduced survival in patients with malignancy undergoing non-cardiac surgery

Background Patients with malignancy undergoing non-cardiac surgery are particularly vulnerable to perioperative cardiovascular complications. While postoperative atrial fibrillation (POAF) is a common perioperative arrhythmia. its long-term prognostic significance in oncology patients remains incompletely defined. Purpose To evaluate the prognostic impact of POAF on 1-year all-cause mortality in patients undergoing non-cardiac surgery, with a particular focus on whether this association differs between patients with and without malignancy. Methods We retrospectively evaluated 179 consecutive patients undergoing non-cardiac surgery. including 78 patients with malignancy. The primary endpoint was 1-year all-cause mortality. Survival was assessed using Kaplan–Meier analysis with log-rank testing. Cox proportional hazards regression was performed to evaluate the independent association between POAF and mortality. Results POAF occurred in 16 patients (8.9%) overall and was more frequent among patients with malignancy than those without (14.1% vs 5.0%. p=0.038). In the overall cohort. 1-year mortality was significantly higher in patients who developed POAF compared with those who did not (75.0% vs 23.3%. p<0.001). Subgroup analyses demonstrated that this association was predominantly observed in patients with malignancy. Among malignant patients. 1-year mortality was markedly higher in those with POAF compared with those without (90.9% vs 22.4%. p<0.001). whereas no significant association was observed in non-malignant patients (40.0% vs 24.0%. p=0.595). Kaplan–Meier analysis revealed significantly reduced survival with early and sustained separation of survival curves in malignancy patients with POAF (log-rank p=0.006). In multivariable Cox regression analysis restricted to patients with malignancy. POAF remained independently associated with increased mortality (hazard ratio 2.97. 95% confidence interval 1.25–7.06; p=0.014). Conclusions POAF identifies a uniquely high-risk phenotype characterized by markedly increased and earlier mortality among patients with malignancy undergoing non-cardiac surgery. In this population. POAF appears to represent a clinically meaningful marker of cardiovascular vulnerability rather than a transient perioperative arrhythmia.