Atrial Fibrillation in Patients with Septic Shock: A One-Year Observational Pilot Study

Abstract

Objective:The negative effect of sepsis on the myocardium affects its electric functionality. This study aims to evaluate the incidence of atrial fibrillation (AF) in patients with septic shock, and the mortality rate of patients with AF versus patients that maintained sinus rhythm (SR).Methods: This is a one-year observational prospective pilot study. It was conducted at the Department of Anaesthesia and Intensive Care of Pisa University. Patients with septic shock were enrolled in this study. They were divided in two groups based on the occurrence of AF while in the ICU. Data were collected at admission and after 72 hours, and the data consisted of anamnesis, vital parameters, blood results and severity score.Results: Out of 27 patients, 9 developed AF during the first 72 hours. At admission and at 72 hours, SOFA was statistically higher in the patients with AF (p=0.012 and p=0.002, respectively). In the AF group, the overall mortality was 66.7%, whereas, it was 11.1% (p=0.006) in the patients with SR. Age, rhythm and noradrenaline dosage were univariate predictors of total mortality. Conclusion:In patients with septic shock, AF has a high incidence, and it correlated with a worse outcome. Patients with higher SOFA score are at a greater risk of developing arrhythmia.

New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

“…46 Regarding other classical risk factors for AF 47 like diabetes, hypertension, obesity, and cardiovascular disease, 11 studies showed that some of those were associated with new-onset AF in sepsis. [23][24][25][26][27]29,[41][42][43][44][45] However in five studies these classical risk factors were not related with new-onset AF, 20,28,29,40,48 thus underlining that new-onset AF in patients with septic syndromes may also be initiated by elevated levels of pro-inflammatory cytokines by activation of the catecholaminergic system, electrolyte alterations, and alteration in volume status during sepsis. 8, 38,39 Regarding echocardiographic findings, Ferrera et al 26 and Liu et al 25 reported that left atrial dimension was larger in patients with new-onset AF than in those who remained in SR. Conversely, in the study of Guenancia et al, 40 there were no differences in left atrial dimension among patients with new-onset AF and those with SR, although new-onset AF patients had a lower left ventricular ejection fraction than patients in SR. 40 Wetterslev et al 49 used three categories to classify the risk factors for development of new-onset AF in adult critically ill patients: (1) predisposing factors, (2) condition-related precipitating factors, and (3) treatment-related precipitating factors.…”

“…In-hospital mortality in patients with new-onset AF and sepsis was described in 16 studies. In 10 studies, in-hospital mortality was higher in patients with new-onset AF than in patients with SR. 20,[22][23][24][25][26][27][28][29]43 In four studies, 40,44,48,50 the overall ICU-and inhospital mortality rates were similar between patients with and without new-onset AF and two studies were performed in survivors after sepsis. 41,45 Estimated odds ratio (OR) ranged from 1.9 (95% confidence interval [CI], 1.01-4.11) to 5.7 (95% CI, 3.8-8.6) for in-hospital mortality.…”

“…23,28,29,44 Severity scores such as SAPS-II, SOFA, and APACHE II, or the presence of any organ failure, were identified as independent risk factors for new-onset AF in sepsis in up to 10 studies. 20,22,23,25,27,29,41,42,44,48 Three studies reported higher mortality during postdischarge follow-up in patients with sepsis and new-onset AF versus SR at 28 days (72 vs. 38%, p ¼ 0.004), 29 1 year (61 vs. 40%, p < 0.001), 23 and 5 years (75 vs. 72%, p < 0.001). 41 In two studies, the after-discharge mortality rate was similar in patients with and without new-onset AF.…”

“…18 New-onset AF that occurs in the setting of sepsis could be associated with increased length of stay in ICU, 8 long-term stroke risk, and mortality risk. 20,[22][23][24][25][26][27][28][29] The risk of ischemic stroke among patients with new-onset AF during sepsis seems to be higher than in the general population with AF and higher than in patients with sepsis who do not have new-onset AF. 27 However, there is no evidence to support anticoagulant treatment for stroke prevention in patients with new-onset AF during sepsis.…”

“…18 As part of the resulting multiorgan dysfunction, the cardiovascular system can be impaired. [19][20][21] Sepsis is an important public health problem and the incidence of septic syndromes is increasing mainly because of the aging population and more comorbidities. Sepsis is an important cause of mortality and critical illness worldwide.…”