Objectives : To evaluate the prevalence and the risk factors of new onset atrial fibrillation (AF) in a single medical ICU. Methods : A prospective observational study was conducted in a 10 bed single medical ICU over a period of 18 months. All patients with sinus rhythm admitted in the medical ICU were included. Those presenting with any arrhythmia on admission, having a PACEMAKER or having undergone a recent cardiothoracic surgery were excluded. Results : Of the 377 patients included on the study, atrial fibrillation occurred in 26 patients (7%). Patients who developed AF were older, had higher severity scores on admission, and required significantly more fluids, catecholamine, and mechanical ventilation. They had a longer ICU and hospital LOS. ICU mortality was significantly higher in AF patients. Five inde- pendent risk factors of AF were identified by multivariate analysis: advanced age, the presence of COPD, sepsis, car- diogenic shock, and hypoxemia. Conclusion : AF occurs in approximately 7% of medical critically ill patients and is associated with age, a history of COPD, the presence of sepsis, cardiogenic shock and hypoxemia. AF occurs in more critically ill patients and is associated with increased morbidity and mortality.
P. Reinelt, G. D. Karth, A. Geppert and G. Heinz, “Incidence and Type of Cardiac Arrhythmias in Critically Ill Patients: A Multicenter Experience in a Medical-Cardiological ICU,” Intensive Care Medicine, Vol. 27, No. 9, 2001, pp. 1466-1473. doi:10.1007/s001340101043
C. D. Furberg, B. M. Psaty, T. A. Manolio, J. M. Gardin, V. A. Smith and P. M. Rautaharju, “Prevalence of Atrial Fibrillation in Elderly Subjects (The Cardiovascular Health Study),” American Journal of Cardiology, Vol. 74, No. 3, 1994, pp. 236-241. doi:10.1016/0002-9149(94)90363-8
P. Seguin, T. Signouret, B. Laviolle, B. Branger and Y. Mallédant, “Incidence and Risk Factors of Atrial Fibrillation in a Surgical Intensive Care Unit,” Critical Care Medicine, Vol. 32, No. 3, 2004, pp. 722-726. doi:10.1097/01.CCM.0000114579.56430.E0
W. B. Kannel, R. D. Abbott, D. D. Savage and P. M. McNamara, “Coronary Heart Disease and Atrial Fibrillation: The Framingham Study,” American Heart Journal, Vol. 106, No. 2, 1983, pp. 389-396. doi:10.1016/0002-8703(83)90208-9
H. Artucio and M. Peireira, “Cardiac Arrhythmias in Critically Ill Patients: Epidemiologic Study,” Critical Care Medicine, Vol. 18, No. 12, 1990, pp. 1383-1388. doi:10.1097/00003246-199012000-00015
H. Knotzer, A. Mayr, H. Ulmer, W. Lederer, W. Schobersberger, N. Mutz and W. Hasibeder, “Tachyarrhythmias in a Surgical Intensive Care Unit: Case-Controlled Epidemiologic Study,” Intensive Care Medicine, Vol. 26, No. 7, 2000, pp. 908-914. doi:10.1007/s001340051280
W. H. Maisel, J. D. Rawn and W. G. Stevenson, “Atrial Fibrillation after Cardiac Surgery,” Annals of Internal Medicine, Vol. 135, 2001, pp. 1061-1073.
D. Annane, V. Sebille, D. Duboc, J. Y. LeHeuzey, N. Sadoul, E. Bouvier, et al., “Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients,” American Journal of Respiratory and Critical Care Medicine, Vol. 178, No. 1, 2008, pp. 20-25. doi:10.1164/rccm.200701-031OC
S. M. Hollenberg and R. P. Dellinger, “Non Cardiac Surgery: Post Operative Arrhythmias,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 145-150. doi:10.1097/00003246-200010001-00006
W. A. Knaus, E. A. Draper, D. P. Wagner and J. E. Zimmerman, “APACHEII. A Severity Score of Disease Classification System,” Critical Care Medicine, Vol. 13, No. 10, 1985, pp. 818-829. doi:10.1097/00003246-198510000-00009
J. R. Le Gall, S. Lemeshow and F. Saulnier, “A New Simplified Acute Physiology Score (SAPSII) Based on a European/North American Multicenter Study,” Journal of the American Medical Association, Vol. 270, 1993, pp. 2957-2963. doi:10.1001/jama.270.24.2957
Commission d’Evaluation de la Société de réAnimation en Langue Fran?aise. Utilisation de l’Indice de Gravité Simplifié et du Système Oméga. Mise à Jour 1986,” Réanimation Soins Intensifs Med Urgences, Vol. 2, 1986, pp. 219-221.
M. M. Levy, M. P. Fink, J. C. Marshall, E. Abraham, D. Angus, D. Cook, J. Cohen, S. M. Opal, J. L. Vincent and G. Ramsay, “2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference,” Critical Care Medicine, Vol. 31, No. 4, 2003, pp. 1250-1256. doi:10.1097/01.CCM.0000050454.01978.3B
M. M. Levy, J. M. Carlet, J. Bion, M. M. Parker, R. Jaeschke, et al., “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” Intensive Care Medicine, Vol. 34, No. 1, 2008, pp. 17-60. doi:10.1007/s00134-007-0934-2
R. L. Mehta, J. A. Kellum, S. V. Shah, B. A. Molitoris, C. Ronco, et al., “Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury,” Critical Care, Vol. 11, 2007, p. R31. doi:10.1186/cc5713
R. Meierhenrich, E. Steinhilber, C. Eggermann, M. Weiss, et al., “Incidence and Prognostic Impact of New-Onset Atrial Fibrillation in Patients with Septic Shock: A Prospective Observational Study,” Critical Care, Vol. 14, 2010, p. R108. doi:10.1186/cc9057
P. Seguin, B. Laviolle, A. Maurice, C. Leclercq and Y. Malledant, “Atrial Fibrillation in Trauma Patients Requiring Intensive Care,” Intensive Care Medicine, Vol. 32, No. 3, 2006, pp. 398-404. doi:10.1007/s00134-005-0032-2
D. Brathwaite and C. Weissman, “The New Onset of Atrial Arrhythmias Following Major Noncardiothoracic Surgery Is Associated with Increased Mortality,” Chest, Vol. 114, No. 2, 1998, pp. 462-468. doi:10.1378/chest.114.2.462
L. Goldman, “Supraventricular Tachyarrhythmias in Hospitalized Adults after Surgery. Clinical Correlates in Patients over 40 Years of Age after Major Noncardiac Surgery,” Chest, Vol. 73, No. 4, 1978, pp. 450-454. doi:10.1378/chest.73.4.450
J. S. Bender, “Supraventricular Tachyarrhythmias in the Surgical Intensive Care Unit: An Under-Recognized Event,” American Surgeon, Vol. 62, No. 1, 1996, pp. 73- 75.
D. Amar, H. Zhang, D. H. Y. Leung, N. Poistacher and A. H. Kadish, “Older Age Is the Strongest Predictor of Post-operative Atrial Fibrillation,” Anesthesiology, Vol. 96, No. 2, 2002, pp. 352-356. doi:10.1097/00000542-200202000-00021
B. M. Psaty, T. A. Manolio, L. H. Kuller, R. A. Kronmal, M. Cushman, L. P. Fried, et al., “Incidence and Risk Factors for Atrial Fibrillation in Older Adults,” Circulation, Vol. 96, No. 2, 1997, pp. 2455-2461. doi:10.1161/01.CIR.96.7.2455
T. Liu, G. P. Li and L. J. Li, “Atrial Dilatation and Atrial Fibrillation: A Vicious Circle?” Medical Hypotheses, Vol. 65, No. 2, 2005, pp. 410-411. doi:10.1016/j.mehy.2005.03.004
T. T. Issac, H. Dokainish and N. M. Lakkis, “Role of Inflammation in Initiation and Perpetuation of Atrial Fibrillation: A Systematic Review of the Published Data,” Journal of the American College of Cardiology, Vol. 50, No. 21, 2007, pp. 2021-2028. doi:10.1016/j.jacc.2007.06.054
R. J. Aviles, D. O. Martin, C. Apperson-Hansen, P. L. Houghtaling, P. Rautaharju, R. A. Kronmal, R. P. Tracy, D. R. Van Wagoner, B. M. Psaty, M. S. Lauer and M. K. Chung, “Inflammation as a Risk Factor for Atrial Fibrillation,” Circulation, Vol. 108, 2003, pp. 3006-3010. doi:10.1161/01.CIR.0000103131.70301.4F
M. K. Chung, D. O. Martin, D. Sprecher, O. Wazni, A. Kanderian, C. A. Carnes, J. A. Bauer, P. J. Tchou, M. J. Niebauer, A. Natale and D. R. Van Wagoner, “C-Reactive Protein Elevation in Patients with Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation,” Circulation, Vol. 104, 2001, pp. 2886-2891. doi:10.1161/hc4901.101760
K. Ramaswamy and M. H. Hamdan, “Ischemia, Metabolic Disturbances and Arrhythmogenesis: Mechanisms and Management,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 151-157. doi:10.1097/00003246-200010001-00007
S. M. Hollenberg and R. P. Dellinger, “Noncardiac Surgery: Postoperative Arrhythmias,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 145-150. doi:10.1097/00003246-200010001-00006