New-Onset Atrial Fibrillation in the Critically Ill

作者：Moss Travis J; Calland James Forrest; Enfield Kyle B; Gomez Manjarres Diana C; Ruminski Caroline; DiMarco John P; Lake Douglas E; Moorman J Randall^*

来源：Critical Care Medicine, 2017, 45(5): 790-797.

DOI：10.1097/CCM.0000000000002325

• electrocardiography
• intensive care unit
• length of stay
• mortality
• survival

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 sub clinical 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.

• 出版日期2017-5