Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation

Authors: Wen Cheng Liu, Wen Yu Lin, Chin Sheng Lin, Han Bin Huang, Tzu Chiao Lin, Shu Meng Cheng, Shih Ping Yang, Jung Chung Lin, Wei Shiang Lin

Published in: Critical Care | Issue 1/2016

Login to get access

Abstract

Background

New-onset atrial fibrillation (NeOAF) is a common type of tachyarrhythmia in critically ill patients and is associated with increased mortality in patients with sepsis. However, the prognostic impact of restored sinus rhythm (SR) in septic patients with NeOAF remains unclear.

Methods

A total of 791 patients with sepsis, who were admitted to a medical intensive care unit from January 2011 to January 2014, were screened. NeOAF was detected by continuous electrocardiographic monitoring. Patients were categorized into three groups: no NeOAF, NeOAF with restored SR (NeOAF to SR), and NeOAF with failure to restore SR (NeOAF to atrial fibrillation (AF)). The endpoint of this study was in-hospital mortality. Patients with pre-existing AF were excluded.

Results

We reviewed the data of 503 eligible patients, including 263 patients with no NeOAF and 240 patients with NeOAF. Of these 240 patients, SR was restored in 165 patients, and SR could not be restored in 75 patients. The NeOAF to AF group had the highest in-hospital mortality rate of 61.3% compared with the NeOAF to SR and no NeOAF groups (26.1% and 17.5%, respectively). Moreover, multivariate logistic regression analysis revealed that failure of restored SR was independently associated with increased in-hospital mortality in patients with sepsis and NeOAF.

Conclusions

Failure to restore a sinus rhythm in patients with new-onset atrial fibrillation may be associated with increased in-hospital mortality in patients with sepsis. Further prospective studies are needed to clarify the effects of restoration of sinus rhythm on survival in patients with sepsis and new-onset atrial fibrillation.
Appendix
Available only for authorised users
Literature
1.
Artucio H, Pereira M. Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med. 1990;18(12):1383–8.CrossRefPubMed
2.
Annane D, Sébille V, Duboc D, Le Heuzey JY, Sadoul N, Bouvier E, et al. Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Respir Crit Care Med. 2008;178(1):20–5.CrossRefPubMed
3.
Nisanoglu V, Erdil N, Aldemir M, Ozgur B, Berat Cihan H, Yologlu S, et al. Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis. Thorac Cardiovasc Surg. 2007;55:32–8.CrossRefPubMed
4.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135:1061–73.CrossRefPubMed
5.
Kalavrouziotis D, Buth KJ, Ali IS. The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery. Chest. 2007;131:833–9.CrossRefPubMed
6.
Seguin P, Signouret T, Laviolle B, Branger B, Mallédant Y. Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med. 2004;32:722–6.CrossRefPubMed
7.
Brathwaite D, Weissman C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest. 1998;114:462–8.CrossRefPubMed
8.
Seguin P, Laviolle B, Maurice A, Leclercq C, Mallédant Y. Atrial fibrillation in trauma patients requiring intensive care. Intensive Care Med. 2006;32(3):398–404.CrossRefPubMed
9.
Hadjizacharia P, O’Keeffe T, Brown CV, Inaba K, Salim A, Chan LS, et al. Incidence, risk factors, and outcomes for atrial arrhythmias in trauma patients. Am Surg. 2011;77(5):634–9.PubMed
10.
Sander O, Welters ID, Foëx P, Sear JW. Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications. Crit Care Med. 2005;33:81–8.CrossRefPubMed
11.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.CrossRefPubMed
12.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.CrossRefPubMed
13.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefPubMedPubMedCentral
14.
Arora S, Lang I, Nayyar V, Stachowski E, Ross DL. Atrial fibrillation in a tertiary care multidisciplinary intensive care unit-incidence and risk factors. Anaesth Intensive Care. 2007;35:707–13.PubMed
15.
Goodman S, Shirov T, Weissman C. Supraventricular arrhythmias in intensive care unit patients: short and long-term consequences. Anesth Analg. 2007;104:880–6.CrossRefPubMed
16.
Christian SA, Schorr C, Ferchau L, Jarbrink ME, Parrillo JE, Gerber DR. Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. J Crit Care. 2008;23:532–6.CrossRefPubMed
17.
Salman S, Bajwa A, Gajic O, Afessa B. Paroxysmal atrial fibrillation in critically ill patients with sepsis. J Intensive Care Med. 2008;23(3):178–83.CrossRefPubMed
18.
Meierhenrich R, Steinhilber E, Eggermann C, Weiss M, Voglic S, Bögelein D, et al. Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study. Crit Care. 2010;14:R108.CrossRefPubMedPubMedCentral
19.
Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306(20):2248–54.CrossRefPubMedPubMedCentral
20.
Walkey AJ, Greiner MA, Heckbert SR, Jensen PN, Piccini JP, Sinner MF, et al. Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors. Am Heart J. 2013;165(6):949–55.CrossRefPubMedPubMedCentral
21.
Chen AY, Sokol SS, Kress JP, Lat I. New-onset atrial fibrillation is an independent predictor of mortality in medical intensive care unit patients. Ann Pharmacother. 2015;49(5):523–7.CrossRefPubMed
22.
Kuipers S, Klein Klouwenberg PM, Cremer OL. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care. 2014;18(6):688.CrossRefPubMedPubMedCentral
23.
Gandhi S, Litt D, Narula N. New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality. Neth Heart J. 2015;23(2):82–8.CrossRefPubMedPubMedCentral
24.
Shaver CM, Chen W, Janz DR, May AK, Darbar D, Bernard GR, et al. Atrial fibrillation is an independent predictor of mortality in critically ill patients. Crit Care Med. 2015;43(10):2104–11.CrossRefPubMedPubMedCentral
25.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefPubMed
26.
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793–800.CrossRefPubMed
27.
Szklo M, Nieto FJ. Epidemiology: Beyond the basics. 2nd ed. Sudbury: Jones and Bartlett Publishers; 2007.
28.
Issac TT, Dokainish H, Lakkis NM. Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol. 2007;50(21):2021–8.CrossRefPubMed
29.
Hu YF, Chen YJ, Lin YJ, Chen SA. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015;12:230–43.CrossRefPubMed
30.
31.
Brown SM, Tate Q, Jones JP, Knox DB, Kuttler KG, Lanspa M, et al. Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study. J Crit Care. 2013;28:959–63.CrossRefPubMed
32.
Rudiger A, Singer M. Mechanisms of sepsis-induced cardiac dysfunction. Crit Care Med. 2007;35:1599–608.CrossRefPubMed
33.
De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779–89.CrossRefPubMed
34.
Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108(24):3006–10.CrossRefPubMed
35.
36.
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5.CrossRefPubMed
37.
Marcus GM, Smith LM, Glidden DV, Wilson E, McCabe JM, Whiteman D, et al. Markers of inflammation before and after curative ablation of atrial flutter. Heart Rhythm. 2008;5(2):215–21.CrossRefPubMed
38.
Kallergis EM, Manios EG, Kanoupakis EM, Mavrakis HE, Kolyvaki SG, Lyrarakis GM, et al. The role of the postcardioversion time course of hs-CRP levels in clarifying the relationship between inflammation and persistence of atrial fibrillation. Heart. 2008;94(2):200–4.CrossRefPubMed
39.
Viswanathan K, Daniak SM, Salomone K, Kiely T, Patel U, Converso K, et al. Effect of cardioversion of atrial fibrillation on improvement in left ventricular performance. Am J Cardiol. 2001;88(4):439–41.CrossRefPubMed
40.
41.
Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA. 2013;310(16):1683–91.CrossRefPubMed
42.
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33.CrossRefPubMed
43.
Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M, et al. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001;29(6):1149–53.CrossRefPubMed
44.
Hou ZY, Chang MS, Chen CY, Tu MS, Lin SL, Chiang HT, et al. Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. A randomized, digoxin-controlled study. Eur Heart J. 1995;16(4):521–8.PubMed
45.
Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest. 2014;146(5):1187–95.CrossRefPubMedPubMedCentral
Metadata
Title
Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation
Authors
Wen Cheng Liu
Wen Yu Lin
Chin Sheng Lin
Han Bin Huang
Tzu Chiao Lin
Shu Meng Cheng
Shih Ping Yang
Jung Chung Lin
Wei Shiang Lin
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1548-2

Other articles of this Issue 1/2016

Critical Care 1/2016 Go to the issue

Commentary

We need to optimize piperacillin-tazobactam dosing in critically ill patients—but how?

Letter

Early antibiotic treatment for gradual ventilator-associated pneumonia: yes or no?

Erratum

Erratum to: ‘Neutrophil CD64 expression as a diagnostic marker for sepsis in adult patients: a meta-analysis’

Commentary

Simple equations for complex physiology: can we use VCO2 for calculating energy expenditure?

Commentary

Latent AKI is… still AKI: the quantification of the burden of renal dysfunction

Research

Manual versus Automated moNitoring Accuracy of GlucosE II (MANAGE II)