AIM: To evaluate the value of plasma N-terminal pro- brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma.METHODS: NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma.All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery,and then underwent clinical cardiac evaluation until discharge.RESULTS: Postoperative AF occurred in 11 patients (7.7%).AF patients were significantly older (69.6±12.2years vs 63.4±13.3 years, P = 0.031) than non-AF patients.There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach,anastomosis site, intraoperative hypotension and postoperative fever.The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3±18.3 pg/mL vs 396.1±42.6 pg/mL, P = 0.016).After adjustment for age, gender,chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008).CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma.This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.