Prevalence and Temporal Distribution of Extrasystoles in Septic ICU Patients: The Feasibility of Predicting Fluid Responsiveness Using Extrasystoles

Abstract

Background Extrasystoles may be useful for predicting the response to fluid therapy in hemodynamically unstable patients but their prevalence is unknown. The aim of this study was to estimate the availability of extrasystoles in intensive care unit patients diagnosed with sepsis. The study aim was not to validate the fluid responsiveness prediction ability of extrasystoles. Methods Twenty-four-hour ECG recordings from a convenience sample of 50 patients diagnosed with sepsis were extracted from the MIMIC-II waveform database, and ECGs were visually examined for correct QRS complex detection. Custom-made algorithms identified potential extrasystoles based on RR intervals. Two raters visually confirmed or rejected the potential extrasystoles and then classified them as ventricular, supraventricular, or unknown origin. Extrasystole availability was calculated as extrasystolic coverage for each 24 h ECG recording, that is, the percentage of the 24 h recording where an extrasystole had occurred in the preceding 30 minutes. Results Mean extrasystolic coverage was 53.3% (confidence interval: [42.8; 63.6]%) and ventricular extrasystolic coverage was 21.4 [13.5; 29.8]%. Interrater reliability was strong for confirming/rejecting extrasystoles. Conclusions Extrasystoles are available for fluid responsiveness prediction in septic patients in about half of the time. With this extrasystolic availability, we believe the method to be considered for clinical use, provided that future studies validate the method's fluid responsiveness prediction ability.

Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery

“…Prior to initiating the study, the expected occurrence of extrasystoles was determined retrospectively inspecting ectopic activity as captured by the Philips ® monitoring system from 59 cardiac surgeries. Approximately 70% of patients had at least one extrasystole, which was similar to a previous study [30]. Estimating conservatively, we therefore planned to include 60 patients.…”

Post-extrasystolic characteristics in the arterial blood pressure waveform are associated with right ventricular dysfunction in intensive care patients

“…An important aspect of this method is therefore also the availability of ventricular extrasystoles, which the present study does not address in an adequately systematic way. However, we recently showed that in septic ICU patients, 76% of patients (32 out 42) with analyzable ECGs had at least one ventricular extrasystole in their 24h ECG recording, of which most were recorded on the first day of ICU admission [18]. In subjects with atrial fibrillation or other frequent arrhythmias such as trigemini, this method cannot be considered.…”