Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study

Knotzer, Hans; Mayr, Andreas; Ulmer, Hanno; Lederer, Wolfgang; Schobersberger, Wolfgang; Mutz, N.; Hasibeder, Walter

doi:10.1007/s001340051280

Cited by 103 publications

(79 citation statements)

References 20 publications

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“…Although A fib is the most frequently reported arrhythmia (14,15,17,19), large epidemiologic studies designed to assess incidence of different arrhythmias in the septic population are lacking. Consistent with our findings, previous studies have found advanced age, male gender and comorbidities such as heart failure, HTN and valvular heart disease to predict new onset A Fib in critically ill patients (5,14,16,20,21). Similarly new onset A fib has consistently been associated with a higher mortality in septic patients (2,4,14).…”

Section: Discussionsupporting

confidence: 91%

“…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%

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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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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…4 Estimates of the incidence of atrial fibrillation in critically ill patients range from 47.4% to 61% of all arrhythmias and 52% of atrial arrhythmias. [5][6][7] In a study 8 of surgical ICU patients, the incidence was 5.3%. In critically ill patients, atrial fibrillation can be initiated by fluid shifts, electrolyte imbalances, neurohormonal disturbances, arrhythmogenic drugs, and systemic inflammatory responses.…”

mentioning

confidence: 99%

“…6,[12][13][14][15][16][17] In a general population and in patients with congestive heart failure, according to data from the Framingham Heart Study, atrial fibrillation is associated with increased risk for death. 18,19 However, evidence on the outcome of atrial fibrillation in general ICU patients is limited and somewhat conflicting.…”

mentioning

confidence: 99%

Atrial Fibrillation and Mortality in Critically Ill Patients: A Retrospective Study

Gupta¹,

Tiruvoipati²,

Green³

2015

American Journal of Critical Care

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“…It has recently been demonstrated that systemic inflammatory response syndrome and sepsis are independent risk factors for the development of atrial tachyarrhythmias. [5][6][7] During induction and maintenance of anesthesia, sympathetic stimulation and hypercapnia could also precipitate the preexisting arrhythmia into MAT and Af, eventually, resulting in intractable rapid ventricular response and impending tachycardia-induced heart failure.…”

Section: Conclusion : De Graves Tachyarythmies Auriculaires Complexesmentioning

confidence: 99%

Successful use of iv diltiazem to control perioperative refractory complex atrial tachyarrhythmias in a patient with pneumoconiosis

Tsou

Chiang

Liou

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To present a patient with pneumoconiosis who developed a complex, life-threatening atrial tachyarrhythmia during anesthesia. Intravenous diltiazem was effective in controlling the ventricular rate and hemodynamics after failure of other antiarrhythmic drugs and direct current cardioversion.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 79-yr-old man with pneumoconiosis complicated by cor pulmonale suffered from gout-related cellulitis of the left lower limb. Debridement of the left gangrenous big toe was carried out under general anesthesia. During anesthesia, a wide-QRS tachycardia occurred suddenly and a complex atrial tachyarrhythmia was later diagnosed. Hemodynamics deteriorated despite aggressive treatment with lidocaine, verapamil, direct current cardioversion, magnesium, digoxin and amiodarone. Correction of the underlying respiratory acidosis was not sufficient to control the rapid ventricular response. Eventually, iv diltiazem adequately controlled the rapid ventricular rate and quickly improved the deteriorating hemodynamics.C Co on nc cl lu us si io on n: : Life-threatening complex atrial tachyarrhythmias may occur in patients with chronic lung diseases perioperatively. Intravenous diltiazem was effective in the management of complex atrial tachyarrhythmia in a patient with underlying cor pulmonale. UPRAVENTRICULAR and ventricular arrhythmias are not uncommon in patients with chronic obstructive lung disease.1,2 The in-hospital morbidity and mortality rates are determined by several factors and mostly associated with a history of coronary artery disease, tachycardia and poor ventricular function. 3 We present a patient with pneumoconiosis and cor pulmonale who developed an intractable and complex, life-threatening atrial tachyarrhythmia perioperatively. The iv infusion of diltiazem proved to be effective.

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Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study

Abstract: In surgical patients hypoxia, high cardiac filling pressures, a greater degree of physiologic derangement at admission, and the presence of SIRS and sepsis are independent risk factors for the development of TA.

Cited by 103 publications

References 20 publications

Severe sepsis and cardiac arrhythmias

Severe sepsis and cardiac arrhythmias

Atrial Fibrillation and Mortality in Critically Ill Patients: A Retrospective Study

Successful use of iv diltiazem to control perioperative refractory complex atrial tachyarrhythmias in a patient with pneumoconiosis

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