Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU

Reinelt, Peter; Karth, Georg Delle; Geppert, Alexander; Gisslinger, Heinz

doi:10.1007/s001340101043

Cited by 142 publications

(105 citation statements)

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“…It is estimated that Ϸ1 in 5 patients admitted to intensive care will develop significant arrhythmias, most commonly atrial fibrillation or ventricular tachycardia. 34 Clinically significant arrhythmias have been reported in a variety of surgical populations requiring intensive care, for example, patients undergoing major noncardiothoracic surgery, 35 colorectal surgery, 36 and pulmonary surgery. 37 ECG monitoring should be continued until patients are weaned from mechanical ventilation and are hemodynamically stable.…”

Section: Patients With Indications For Intensive Carementioning

confidence: 99%

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Drew¹,

Califf²,

et al. 2004

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential ...

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Section: Patients With Indications For Intensive Carementioning

confidence: 99%

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Drew¹,

Califf²,

et al. 2004

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“…In general, patients with severe sepsis were more likely to be older in age, to have CHF, PVD, chronic obstructive pulmonary disease (COPD), DM and renal disease. Ischemic heart disease* 2,161,685 [7] 174,130 [10] CHF* 4,048,500 [14] 427,525 [24] PVD* 1,778,205 [6] 166,975 [10] Cerebrovascular disease* 1,952,330 [7] 144,150 [8] Chronic pulmonary disease* 6,493,627 [22] 495,285 [28] DM* 5,967,546 [21] 499,900 [28] DM with complications* 1,143,775 [4] 127,005 [7] Renal disease* 3,668,071 [13] 465,995 [27] Valvular heart disease* 1,717,610 [6] 131,640 [7] *Comparison between two groups done with Chi-square test. All P values significant at <0.05.…”

Section: Resultsmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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Background: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis is limited. The purpose of this study is to examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. Methods:We used hospital discharge data from the Nationwide Inpatient Sample (NIS) during the year 2012. All patients 18 years or older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation (A Fib), atrial flutter (AFL), ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. In order to study the association of arrhythmias with severe sepsis, two groups were defined: group a-with severe sepsis was compared to group b-without severe sepsis. Univariate and multivariate logistic regression methods were used to adjust for potential confounding factors and variables associated with cardiac arrhythmias were determined.Results: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher risk of A Fib (OR, 1.23; 95% CI, 1.21-1.24), AFL (OR, 1.34; 95% CI, 1.30-1.40), VF arrest (OR, 2.58; 95% CI, 2.38-2.79) (OR, 3.31; 95% CI, 3.07-3.57) and non-VF arrest (OR, 4.91; 95% CI,). In the severe sepsis group, cardiac arrhythmia was associated with higher in-hospital mortality (OR, 1.41; 95% CI, 1.37-1.45), length of stay (LOS) >75% quartile (OR, 1.50; 95% CI, 1.46-1.53) and total hospital charges >75% quartile (OR, 1.37; 95% CI, 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus (DM), congestive heart failure (CHF), valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. Conclusions:Patients with severe sepsis are at high risk of atrial and life threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry a significantly higher risk for cardiac arrest and increased mortality.

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“…According to estimates, 23,24 clinically important cardiac arrhythmias will develop in approximately 1 in 5 ICU patients. The incidence of aLQTS and torsades de pointes may be high in hospitalized patients, especially ICU patients, because of the multiple classes of QT-prolonging medications prescribed and an increase in the incidence of other potential risk factors.…”

Section: Discussionmentioning

confidence: 99%

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Kozik

Wung

2012

Critical Care Nurse

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Background Acquired long QT syndrome is a reversible condition that can lead to torsades de pointes and sudden cardiac death. Objective To determine the frequency, onset, frequency of medications, and risk factors for the syndrome in intensive care patients. Methods In a retrospective chart review of 88 subjects, hourly corrected QT intervals calculated by using the Bazett formula were collected. Acquired long QT syndrome was defined as a corrected QT of 500 milliseconds or longer or an increase in corrected QT of 60 milliseconds or greater from baseline level. Risk factors and medications administered were collected from patients’ medical records. Results The syndrome occurred in 46 patients (52%); mean time of onset was 7.4 hours (SD, 9.4) from time of admission. Among the 88 patients, 52 (59%) received a known QTc-prolonging medication. Among the 46 with the syndrome, 23 (50%) received a known QT-prolonging medication. No other risk factor studied was significantly predictive of the syndrome. Conclusions Acquired long QT syndrome occurs in patients not treated with a known QT-prolonging medication, indicating the importance of frequent QT monitoring of all intensive care patients.

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Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU

Abstract: Only one-fifth of patients in this mixed ICU had significant arrhythmias, taking a contemporary definition of arrhythmias. Ventricular tachycardia and atrial fibrillation were the most frequent arrhythmias.

Cited by 142 publications

References 0 publications

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Severe sepsis and cardiac arrhythmias

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

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