Update on cardiac arrhythmias in the ICU

Goodman, Sergey; Weiss, Yoram; Weissman, Charles

doi:10.1097/mcc.0b013e32830a4c5d

Cited by 38 publications

(30 citation statements)

References 51 publications

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“…Reemphasized by the present study, even though arrhythmias may be an early sign of sepsis (1) and are associated with adverse outcomes, there is lack of data regarding evidence based treatment strategies. Moreover, present data mainly focuses on treatment and prevention of A fib (3).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…Evidence of various cardiac arrhythmias in septic patients has been demonstrated by several clinical reports and studies [21][22][23][24][25]. These arrhythmias may be explained by autonomic dysfunction or impairment and involvement of the cardiac conduction system rather than to pre-existing cardiac co-morbidities [26,27].…”

Section: Introductionmentioning

confidence: 98%

“…Since then, differ-ent types of supra-ventricular, ventricular arrhythmic tachycardia and arrhythmic bradycardia in septic critically ill patients have been described [21,[29][30][31][32] (Table 1). Several large epidemiological [24,25,[33][34][35] and small cohort studies [36][37][38][39] have shown strong evidence of new onset arrhythmic tachycardia immediately before the onset of postoperative sepsis.…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Cardiac Arrhythmias in a Septic ICU Population: A Review

Schwartz

Brotfain

Koyfman

et al. 2015

The Journal of Critical Care Medicine

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Progressive cardiovascular deterioration plays a central role in the pathogenesis of multiple organ failure (MOF) caused by sepsis. Evidence of various cardiac arrhythmias in septic patients has been reported in many published studies. In the critically ill septic patients, compared to non-septic patients, new onset atrial fibrillation episodes are associated with high mortality rates and poor outcomes, amongst others being new episodes of stroke, heart failure and long vasopressor usage. The potential mechanisms of the development of new cardiac arrhythmias in sepsis are complex and poorly understood. Cardiac arrhythmias in critically ill septic patients are most likely to be an indicator of the severity of pre-existing critical illness.

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“…Other clinical aspects of sepsis-induced cardiac dysfunction are tachyarrhythmias [44,45], right heart failure [46,47], elevated troponin [48,49] and B-type natriuretic peptide levels [50][51][52].…”

Section: The Heart In Sepsismentioning

confidence: 99%

The Heart in Sepsis: From Basic Mechanisms to Clinical Management

Rudiger¹,

Singer²

2013

Current Vascular Pharmacology

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Septic shock is characterized by circulatory compromise, microcirculatory alterations and mitochondrial damage, which all reduce cellular energy production. In order to reduce the risk of major cell death and a diminished likelihood of recovery, adaptive changes appear to be activated. As a result, cells and organs may survive in a non-functioning hibernation-like condition. Sepsis-induced cardiac dysfunction may represent an example of such functional shutdown. Sepsis-induced myocardial dysfunction is common, corresponds to the severity of sepsis, and is reversible in survivors. Its mechanisms include the attenuation of the adrenergic response at the cardiomyocyte level, alterations of intracellular calcium trafficking and blunted calcium sensitivity of contractile proteins. All these changes are mediated by cytokines. Treatment includes preload optimization with sufficient fluids. However, excessive volume loading is harmful. The first line vasopressor recommended at present is norepinephrine, while vasopressin can be started as a salvage therapy for those not responding to catecholamines. During early sepsis, cardiac output can be increased by dobutamine. While early administration of catecholamines might be necessary to restore adequate organ perfusion, prolonged administration might be harmful. Novel therapies for sepsis-induced cardiac dysfunction are discussed in this article. Cardiac inotropy can be increased by levosimendan, istaroxime or omecamtiv mecarbil without greatly increasing cellular oxygen demands. Heart rate reduction with ivabradine reduces myocardial oxygen expenditure and ameliorates diastolic filling. Beta-blockers additionally reduce local and systemic inflammation. Advances may also come from metabolic interventions such as pyruvate, succinate or high dose insulin substitutions. All these potentially advantageous concepts require rigorous testing before implementation in routine clinical practice. While early administration of catecholamines might be necessary to restore adequate organ perfusion and pressure, prolonged administration might be harmful.Novel therapies for sepsis-induced cardiac dysfunction are discussed in this article. Cardiac inotropy can be increased by levosimendan, istaroxime or omecamtiv mecarbil without greatly increasing cellular oxygen demands. Heart rate reduction with ivabradine will reduce myocardial oxygen expenditure and ameliorate diastolic filling. Beta-blockers additionally reduce local and systemic inflammation. Advances may also come from metabolic interventions such as pyruvate, succinate or high dose insulin substitutions. However, all these potentially advantageous concepts require rigorous testing before implementation in routine clinical practice.-3 -Alain Rudiger & Mervyn Singer: The heart in sepsis

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Update on cardiac arrhythmias in the ICU

Cited by 38 publications

References 51 publications

Severe sepsis and cardiac arrhythmias

Severe sepsis and cardiac arrhythmias

Cardiac Arrhythmias in a Septic ICU Population: A Review

The Heart in Sepsis: From Basic Mechanisms to Clinical Management

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