Abstract: AIM To compare the incidence of atrial fibrillation and the change of heart variability after pulmonary lobectomy through video assisted thoracic surgery or thoracotomy, and to discuss the role of autonomic nerves in the mediation or modulation of atrial fibrillation after pulmonary lobectomy. METHODS Using a single institution database, 224 patients over 60 years of age with normal sinus rhythm were enrolled in the study. One experienced surgeon and an anesthetist carried out the surgery and anesthesia using the same procedure. The hearts were monitored using Holter for more than 96 hours and the new onset of atrial fibrillation was recorded and heart variability was analyzed at different time intervals. RESULTS 112 patients undergoing video-assisted thoracic surgery and 112 patients undergoing thoracotomy were eligible for the study. Atrial fibrillation occurred in 39 patients, and there was no difference between the two groups (VATS19/112, 16.9% and THOR 20/112, 17.9%, P=0.82). The heart variability showed no differences at different time intervals after the operation between the two groups. CONCLUSION Our investigation demonstrated that pulmonary lobectomy through video assisted thoracic surgery does not reduce postoperative atrial fibrillation.