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2017 ; 45
(5
): 790-797
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New-Onset Atrial Fibrillation in the Critically Ill
#MMPMID28296811
Moss TJ
; Calland JF
; Enfield KB
; Gomez-Manjarres DC
; Ruminski C
; DiMarco JP
; Lake DE
; Moorman JR
Crit Care Med
2017[May]; 45
(5
): 790-797
PMID28296811
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OBJECTIVE: To determine the association of new-onset atrial fibrillation with
outcomes, including ICU length of stay and survival. DESIGN: Retrospective cohort
of ICU admissions. We found atrial fibrillation using automated detection (? 90?s
in 30?min) and classed as new-onset if there was no prior diagnosis of atrial
fibrillation. We identified determinants of new-onset atrial fibrillation and,
using propensity matching, characterized its impact on outcomes. SETTING:
Tertiary care academic center. PATIENTS: A total of 8,356 consecutive adult
admissions to either the medical or surgical/trauma/burn ICU with available
continuous electrocardiogram data. INTERVENTIONS: None. MEASUREMENTS AND MAIN
RESULTS: From 74 patient-years of every 15-minute observations, we detected
atrial fibrillation in 1,610 admissions (19%), with median burden less than 2%.
Most atrial fibrillation was paroxysmal; less than 2% of admissions were always
in atrial fibrillation. New-onset atrial fibrillation was subclinical or went
undocumented in 626, or 8% of all ICU admissions. Advanced age, acute respiratory
failure, and sepsis were the strongest predictors of new-onset atrial
fibrillation. In propensity-adjusted regression analyses, clinical new-onset
atrial fibrillation was associated with increased hospital mortality (odds ratio,
1.63; 95% CI, 1.01-2.63) and longer length of stay (2.25 d; CI, 0.58-3.92).
New-onset atrial fibrillation was not associated with survival after hospital
discharge (hazard ratio, 0.99; 95% CI, 0.76-1.28 and hazard ratio, 1.11; 95% CI,
0.67-1.83, respectively, for subclinical and clinical new-onset atrial
fibrillation). CONCLUSIONS: Automated analysis of continuous electrocardiogram
heart rate dynamics detects new-onset atrial fibrillation in many ICU patients.
Though often transient and frequently unrecognized, new-onset atrial fibrillation
is associated with poor hospital outcomes.
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