IJCM  Vol.3 No.7 , December 2012
New Onset of Atrial Fibrillation in a Medical ICU: Prevalence and Risk Factors
Abstract: Objectives: To evaluate the prevalence and the risk factors of new onset atrial fibrillation (AF) in a single medical ICU. Methods: A prospective observational study was conducted in a 10 bed single medical ICU over a period of 18 months. All patients with sinus rhythm admitted in the medical ICU were included. Those presenting with any arrhythmia on admission, having a PACEMAKER or having undergone a recent cardiothoracic surgery were excluded. Results: Of the 377 patients included on the study, atrial fibrillation occurred in 26 patients (7%). Patients who developed AF were older, had higher severity scores on admission, and required significantly more fluids, catecholamine, and mechanical ventilation. They had a longer ICU and hospital LOS. ICU mortality was significantly higher in AF patients. Five inde- pendent risk factors of AF were identified by multivariate analysis: advanced age, the presence of COPD, sepsis, car- diogenic shock, and hypoxemia. Conclusion: AF occurs in approximately 7% of medical critically ill patients and is associated with age, a history of COPD, the presence of sepsis, cardiogenic shock and hypoxemia. AF occurs in more critically ill patients and is associated with increased morbidity and mortality.
Cite this paper: S. Ayed, S. Atig, N. Tilouche, H. Ali, R. Gharbi, M. Hassen and S. Elatrous, "New Onset of Atrial Fibrillation in a Medical ICU: Prevalence and Risk Factors," International Journal of Clinical Medicine, Vol. 3 No. 7, 2012, pp. 582-586. doi: 10.4236/ijcm.2012.37105.

[1]   P. Reinelt, G. D. Karth, A. Geppert and G. Heinz, “Incidence and Type of Cardiac Arrhythmias in Critically Ill Patients: A Multicenter Experience in a Medical-Cardiological ICU,” Intensive Care Medicine, Vol. 27, No. 9, 2001, pp. 1466-1473. doi:10.1007/s001340101043

[2]   C. D. Furberg, B. M. Psaty, T. A. Manolio, J. M. Gardin, V. A. Smith and P. M. Rautaharju, “Prevalence of Atrial Fibrillation in Elderly Subjects (The Cardiovascular Health Study),” American Journal of Cardiology, Vol. 74, No. 3, 1994, pp. 236-241. doi:10.1016/0002-9149(94)90363-8

[3]   P. Seguin, T. Signouret, B. Laviolle, B. Branger and Y. Mallédant, “Incidence and Risk Factors of Atrial Fibrillation in a Surgical Intensive Care Unit,” Critical Care Medicine, Vol. 32, No. 3, 2004, pp. 722-726. doi:10.1097/01.CCM.0000114579.56430.E0

[4]   W. B. Kannel, R. D. Abbott, D. D. Savage and P. M. McNamara, “Coronary Heart Disease and Atrial Fibrillation: The Framingham Study,” American Heart Journal, Vol. 106, No. 2, 1983, pp. 389-396. doi:10.1016/0002-8703(83)90208-9

[5]   H. Artucio and M. Peireira, “Cardiac Arrhythmias in Critically Ill Patients: Epidemiologic Study,” Critical Care Medicine, Vol. 18, No. 12, 1990, pp. 1383-1388. doi:10.1097/00003246-199012000-00015

[6]   H. Knotzer, A. Mayr, H. Ulmer, W. Lederer, W. Schobersberger, N. Mutz and W. Hasibeder, “Tachyarrhythmias in a Surgical Intensive Care Unit: Case-Controlled Epidemiologic Study,” Intensive Care Medicine, Vol. 26, No. 7, 2000, pp. 908-914. doi:10.1007/s001340051280

[7]   W. H. Maisel, J. D. Rawn and W. G. Stevenson, “Atrial Fibrillation after Cardiac Surgery,” Annals of Internal Medicine, Vol. 135, 2001, pp. 1061-1073.

[8]   D. Annane, V. Sebille, D. Duboc, J. Y. LeHeuzey, N. Sadoul, E. Bouvier, et al., “Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients,” American Journal of Respiratory and Critical Care Medicine, Vol. 178, No. 1, 2008, pp. 20-25. doi:10.1164/rccm.200701-031OC

[9]   S. M. Hollenberg and R. P. Dellinger, “Non Cardiac Surgery: Post Operative Arrhythmias,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 145-150. doi:10.1097/00003246-200010001-00006

[10]   W. A. Knaus, E. A. Draper, D. P. Wagner and J. E. Zimmerman, “APACHEII. A Severity Score of Disease Classification System,” Critical Care Medicine, Vol. 13, No. 10, 1985, pp. 818-829. doi:10.1097/00003246-198510000-00009

[11]   J. R. Le Gall, S. Lemeshow and F. Saulnier, “A New Simplified Acute Physiology Score (SAPSII) Based on a European/North American Multicenter Study,” Journal of the American Medical Association, Vol. 270, 1993, pp. 2957-2963. doi:10.1001/jama.270.24.2957

[12]   Commission d’Evaluation de la Société de réAnimation en Langue Fran?aise. Utilisation de l’Indice de Gravité Simplifié et du Système Oméga. Mise à Jour 1986,” Réanimation Soins Intensifs Med Urgences, Vol. 2, 1986, pp. 219-221.

[13]   M. M. Levy, M. P. Fink, J. C. Marshall, E. Abraham, D. Angus, D. Cook, J. Cohen, S. M. Opal, J. L. Vincent and G. Ramsay, “2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference,” Critical Care Medicine, Vol. 31, No. 4, 2003, pp. 1250-1256. doi:10.1097/01.CCM.0000050454.01978.3B

[14]   M. M. Levy, J. M. Carlet, J. Bion, M. M. Parker, R. Jaeschke, et al., “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” Intensive Care Medicine, Vol. 34, No. 1, 2008, pp. 17-60. doi:10.1007/s00134-007-0934-2

[15]   R. L. Mehta, J. A. Kellum, S. V. Shah, B. A. Molitoris, C. Ronco, et al., “Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury,” Critical Care, Vol. 11, 2007, p. R31. doi:10.1186/cc5713

[16]   R. Meierhenrich, E. Steinhilber, C. Eggermann, M. Weiss, et al., “Incidence and Prognostic Impact of New-Onset Atrial Fibrillation in Patients with Septic Shock: A Prospective Observational Study,” Critical Care, Vol. 14, 2010, p. R108. doi:10.1186/cc9057

[17]   P. Seguin, B. Laviolle, A. Maurice, C. Leclercq and Y. Malledant, “Atrial Fibrillation in Trauma Patients Requiring Intensive Care,” Intensive Care Medicine, Vol. 32, No. 3, 2006, pp. 398-404. doi:10.1007/s00134-005-0032-2

[18]   D. Brathwaite and C. Weissman, “The New Onset of Atrial Arrhythmias Following Major Noncardiothoracic Surgery Is Associated with Increased Mortality,” Chest, Vol. 114, No. 2, 1998, pp. 462-468. doi:10.1378/chest.114.2.462

[19]   L. Goldman, “Supraventricular Tachyarrhythmias in Hospitalized Adults after Surgery. Clinical Correlates in Patients over 40 Years of Age after Major Noncardiac Surgery,” Chest, Vol. 73, No. 4, 1978, pp. 450-454. doi:10.1378/chest.73.4.450

[20]   J. S. Bender, “Supraventricular Tachyarrhythmias in the Surgical Intensive Care Unit: An Under-Recognized Event,” American Surgeon, Vol. 62, No. 1, 1996, pp. 73- 75.

[21]   D. Amar, H. Zhang, D. H. Y. Leung, N. Poistacher and A. H. Kadish, “Older Age Is the Strongest Predictor of Post-operative Atrial Fibrillation,” Anesthesiology, Vol. 96, No. 2, 2002, pp. 352-356. doi:10.1097/00000542-200202000-00021

[22]   B. M. Psaty, T. A. Manolio, L. H. Kuller, R. A. Kronmal, M. Cushman, L. P. Fried, et al., “Incidence and Risk Factors for Atrial Fibrillation in Older Adults,” Circulation, Vol. 96, No. 2, 1997, pp. 2455-2461. doi:10.1161/01.CIR.96.7.2455

[23]   T. Liu, G. P. Li and L. J. Li, “Atrial Dilatation and Atrial Fibrillation: A Vicious Circle?” Medical Hypotheses, Vol. 65, No. 2, 2005, pp. 410-411. doi:10.1016/j.mehy.2005.03.004

[24]   T. T. Issac, H. Dokainish and N. M. Lakkis, “Role of Inflammation in Initiation and Perpetuation of Atrial Fibrillation: A Systematic Review of the Published Data,” Journal of the American College of Cardiology, Vol. 50, No. 21, 2007, pp. 2021-2028. doi:10.1016/j.jacc.2007.06.054

[25]   R. J. Aviles, D. O. Martin, C. Apperson-Hansen, P. L. Houghtaling, P. Rautaharju, R. A. Kronmal, R. P. Tracy, D. R. Van Wagoner, B. M. Psaty, M. S. Lauer and M. K. Chung, “Inflammation as a Risk Factor for Atrial Fibrillation,” Circulation, Vol. 108, 2003, pp. 3006-3010. doi:10.1161/01.CIR.0000103131.70301.4F

[26]   M. K. Chung, D. O. Martin, D. Sprecher, O. Wazni, A. Kanderian, C. A. Carnes, J. A. Bauer, P. J. Tchou, M. J. Niebauer, A. Natale and D. R. Van Wagoner, “C-Reactive Protein Elevation in Patients with Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation,” Circulation, Vol. 104, 2001, pp. 2886-2891. doi:10.1161/hc4901.101760

[27]   K. Ramaswamy and M. H. Hamdan, “Ischemia, Metabolic Disturbances and Arrhythmogenesis: Mechanisms and Management,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 151-157. doi:10.1097/00003246-200010001-00007

[28]   S. M. Hollenberg and R. P. Dellinger, “Noncardiac Surgery: Postoperative Arrhythmias,” Critical Care Medicine, Vol. 28, No. 10, 2000, pp. 145-150. doi:10.1097/00003246-200010001-00006