Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients

Yoshida, Takuo; Uchino, Shigehiko; Sasabuchi, Yusuke; Hagiwara, Yasuhiro

doi:10.1007/s00134-019-05822-8

Cited by 18 publications

(22 citation statements)

References 36 publications

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“…It may be that cardiac arrhythmias reflects disease severity directly (eg cardiac involvement and/or endogenous catecholamines) or indirectly (eg consequences of the life‐supportive interventions) or increases mortality in itself or that the interventions used against arrhythmias cause serious adverse events. The potential causalities around this, if any, are still debated in critically ill patients in general 26‐32 …”

Section: Discussionmentioning

confidence: 99%

Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population‐based cohort study

Wetterslev

Jacobsen

Hassager

et al. 2021

Acta Anaesthesiol Scand

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Background Coronavirus disease 2019 (COVID‐19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID‐19. Methods We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona‐virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes. Results From the seven ICUs we included 155 patients with COVID‐19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30‐45), and 39/57 (68%) of these patients had this as new‐onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty‐four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60‐day mortality (63%) as compared to those without arrhythmias (39%). Conclusion New‐onset supraventricular arrhythmias were frequent in ICU patients with COVID‐19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population‐based cohort study

Wetterslev

Jacobsen

Hassager

et al. 2021

Acta Anaesthesiol Scand

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“…Proposed mechanisms include direct toxic effect on the cardiac electric system, augmented loading imposed on cardiomyocytes, inflammation, sympathetic hyperactivity, ischemia and pharmacological agents, including antibiotics. AF occurrence is associated with worse short and long term outcomes in patients with infections [26,27], directly influencing patient management, namely the decision to initiate anticoagulation, and conditioning rhythm or rate control strategies.…”

Section: Cardiac Rhythm Disturbancesmentioning

confidence: 99%

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

Tralhão

Póvoa

2020

JCM

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Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6–18.9), acute coronary syndromes in 4.5% (95% CI 2.9–6.5), heart failure in 9.2% (95% CI 6.7–12.2), arrhythmias in 7.2% (95% CI 5.6–9.0) and stroke in 0.71% (95% CI 0.1–3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39–5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.

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“…However, both the previous randomized trial and the present trial examined the hospitalization period as a secondary endpoint because of the insufficient sample size. In a recent study, sustained AF led to a high mortality rate and longer length of ICU stay in noncardiac patients in the ICU [23]. These post-esophagectomy outcomes are also important.…”

Section: Discussionmentioning

confidence: 99%

Landiolol hydrochloride for prevention of atrial fibrillation during esophagectomy: a randomized controlled trial

et al. 2020

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Introduction: Landiolol hydrochloride reduces the incidence of perioperative atrial fibrillation (AF) in cardiac surgery; however, little evidence is available regarding its effects in other types of surgery, including esophagectomy. We assessed the hypothesis that landiolol reduces perioperative AF and other complications associated with esophagectomy. Methods: This single-center, randomized, double-blind, parallel-group study enrolled patients scheduled for esophagectomy. Patients were divided into those given landiolol at 3 μg/kg/min or placebo for 24 h. The primary outcome was the proportion of patients who developed AF within 96 h starting at 9:00 AM on the day of surgery. The secondary outcomes were the proportion of patients whose AF appeared within 24 h, other complications based on the Clavien-Dindo classification, and the intensive care unit and hospital stays. Results: Despite early study termination, 80 patients were screened, and 56 were enrolled (28/group) from September 2016 to June 2018. AF occurred within 96 h of surgery in six (21.4%) patients in the landiolol group and five (17.9%) patients in the placebo group (odds ratio, 1.26; 95% confidence interval, 0.33-4.7) and within 24 h of surgery in three (10.7%) patients in the landiolol group and two (7.1%) patients in the placebo group. There were no significant differences in the incidence of complications or in the number of intensive care unit or hospital stays between the groups. Conclusion: Although our small sample size prevents definitive conclusions, landiolol might not reduce the occurrence of AF or other complications.

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Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients

Cited by 18 publications

References 36 publications

Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population‐based cohort study

Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population‐based cohort study

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

Landiolol hydrochloride for prevention of atrial fibrillation during esophagectomy: a randomized controlled trial

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