Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring

Abstract

PurposeWe investigated incidence, risk factors for new-onset atrial fibrillation (NAF), and prognostic impact during septic shock in medical Intensive Care Unit (ICU) patients.MethodsProspective, observational study in a university hospital. Consecutive patients from 03/2011 to 05/2013 with septic shock were eligible. Exclusion criteria were age <18 years, history of AF, transfer with prior septic shock. Included patients were equipped with long-duration (7 days) Holter ECG monitoring. NAF was defined as an AF episode lasting >30 seconds. Patient characteristics, infection criteria, cardiovascular parameters, severity of illness, support therapies were recorded.ResultsAmong 66 patients, 29(44%) developed NAF; 10 (34%) would not have been diagnosed without Holter ECG monitoring. NAF patients were older, with more markers of heart failure (troponin and NT-pro-BNP), lower left ventricular ejection fraction (LVEF), longer QRS duration and more nonsustained supra ventricular arrhythmias (<30s) on day 1 than patients who maintained sinus rhythm. By multivariate analysis, age (OR: 1.06; p = 0.01) and LVEF<45% (OR: 13.01, p = 0.03) were associated with NAF. NAF did not predict 28 or 90 day mortality.ConclusionsNAF is common, especially in older patients, and is associated with low ejection fraction. We did not find NAF to be independently associated with higher mortality.

New-onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG-ICU study

“…Our study confirmed a high prevalence of AFib in critically ill patients, previously shown in medical, surgical and cardio-surgical ICU settings 8,12,[17][18][19] . Our data also confirmed that the incidence of AFib during ICU stay is particularly high in the first days of acute illness 7,8,18 .…”

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

“…In the current study, AF was more prevalent in males with age > 65 years as shown previously in both ICU patients and in the general population [2, 4, 11]. This was independent of etiology: in trauma patients, there was no incidence of AF in females.…”

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study

“…AF is associated with an increased risk of mortality in HF patients, and prevention or early detection of AF may be an effective way to reduce morbidity and mortality in these patients. However, “silent” AF poses a challenge with regard to early identification of patients for intervention …”

“…However, "silent" AF poses a challenge with regard to early identification of patients for intervention. [14][15][16] As our ability to detect asymptomatic AF is suboptimal in the absence of an implanted pacemaker, defibrillator, or loop recorder, QRSd might be a useful parameter to select patients for more aggressive screening. In a large study of patients with LV systolic dysfunction, QRSd was independently associated with AF.…”