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Journal of Anesthesia

, Volume 32, Issue 5, pp 681–687 | Cite as

Predictors for sustained new-onset atrial fibrillation in critically ill patients: a retrospective observational study

  • Taisuke Yokota
  • Shigehiko Uchino
  • Takuo Yoshida
  • Tomoko Fujii
  • Masanori Takinami
Original Article
  • 111 Downloads

Abstract

Purpose

Although new-onset atrial fibrillation (AF) is frequently observed in the intensive care unit (ICU), the incidence and predictors for sustained new-onset AF have not been investigated, except for cardiac surgery patients. We have evaluated potential predictors for sustained new-onset AF in a mixed ICU.

Methods

In this retrospective observational study, we screened non-cardiac surgery patients who were admitted to the ICU between January 2010 and December 2013 and had been hospitalized for > 24 h in the ICU. We collected information about heart rhythm 6 h after the onset of AF. We compared detailed patient characteristics between patients with sinus rhythm (SR) and those with sustained AF at 6 h after the onset of AF. Additionally, we applied variable selection using backward elimination based on Akaike’s Information Criterion (AIC). Calibration was performed based on the Hosmer–Lemeshow test.

Results

New-onset AF occurred in 151 of 1718 patients and 99 patients converted to SR at 6 h. Backward elimination identified predictors as follows (AIC = 175.3): CHADS2 score, elective surgery, infection on ICU admission, serum potassium > 4.0 mmol/L, male sex, mechanical ventilation, and diagnostic grouping. The model showed good calibration for sustenance of AF at 6 h after the onset using the Hosmer–Lemeshow Chi-square value of 4.36 (degrees of freedom = 4, p = 0.360) indicating a good fit.

Conclusions

These predictors might be useful in future interventional studies to identify patients who are likely to sustain new-onset AF.

Keywords

Predictors Sustained new-onset AF Critically ill patients AF at 6 h after onset Sinus rhythm 

Notes

Acknowledgements

Departmental funding only.

Author contributions

TY extracted the data, analyzed the data, and wrote the first draft of the manuscript. SU designed the study, supervised the analysis of the data, and critically revised the manuscript. TY extracted the data, interpreted the data and critically revised the manuscript. TF was in charge of statistical analysis and critically revised the manuscript. MT interpreted the data and critically revised the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Yoshida T, Fujii T, Uchino S, Takinami M. Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review. J Intensive Care. 2015;3:19.CrossRefGoogle Scholar
  2. 2.
    Kuipers S, Klein Klouwenberg P, Cremer OL. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care. 2014;18:688.CrossRefGoogle Scholar
  3. 3.
    Prystowsky EN, Padanilam BJ, Fogel RI. Treatment of atrial fibrillation. JAMA. 2015;314:278–88.CrossRefGoogle Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    Klein Klouwenberg PM, Frencken JF, Kuipers S, Ong DS, Peelen LM, van Vught LA, Schultz MJ, van der Poll T, Bonten MJ, Cremer OL, MARS Consortium. Incidence, predictors, and outcomes of new-onset atrial fibrillation in critically ill patients with sepsis. A cohort study. Am J Respir Crit Care Med. 2017;195:205–11.CrossRefGoogle Scholar
  6. 6.
    Moss TJ, Calland JF, Enfield KB, Gomez-Manjarres DC, Ruminski C, DiMarco JP, Lake DE, Moorman JR. New-onset atrial fibrillation in the critically Ill. Crit Care Med. 2017;45:790–7.CrossRefGoogle Scholar
  7. 7.
    Chokengarmwong N, Yeh DD, Chang Y, Ortiz LA, Kaafarani HMA, Fagenholz P, King DR, DeMoya M, Butler K, Lee J, Velmahos G, Januzzi JL, Lee-Lewandrowski E, Lewandrowski K. Elevated admission N-terminal pro-brain natriuretic peptide level predicts the development of atrial fibrillation in general surgical intensive care unit patients. J Trauma Acute Care Surg. 2017;83:485–90.CrossRefGoogle Scholar
  8. 8.
    Yoshida T, Uchino S, Yokota T, Fujii T, Uezono S, Takinami M. The impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients: a retrospective cohort study. J Crit Care. 2018;44:267–72.CrossRefGoogle Scholar
  9. 9.
    Sundararajan K, Flabouris A, Keeshan A, Cramey T. Documentation of limitation of medical therapy at the time of a rapid response team call. Aust Health Rev. 2014;38:218–22.PubMedGoogle Scholar
  10. 10.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefGoogle Scholar
  11. 11.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.CrossRefGoogle Scholar
  12. 12.
    Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.CrossRefGoogle Scholar
  13. 13.
    Sleeswijk ME, Tulleken JE, Van Noord T, Meertens JH, Ligtenberg JJ, Zijlstra JG. Efficacy of magnesium-amiodarone step-up scheme in critically ill patients with new-onset atrial fibrillation: a prospective observational study. J Intensive Care Med. 2008;23:61–6.CrossRefGoogle Scholar
  14. 14.
    Kanji S, Stewart R, Fergusson DA, McIntyre L, Turgeon AF, Hébert PC. Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients: a systematic review of randomized controlled trials. Crit Care Med. 2008;36:1620–4.CrossRefGoogle Scholar
  15. 15.
    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;306:2248–54.CrossRefGoogle Scholar
  16. 16.
    Kotova S, Wang M, Lothrop K, Grunkemeier G, Merry HE, Handy JR. CHADS2 score predicts postoperative atrial fibrillation in patients undergoing elective pulmonary lobectomy. Ann Thorac Surg. 2017;103:1566–72.CrossRefGoogle Scholar
  17. 17.
    Ambrus DB, Benjamin EJ, Bajwa EK, Hibbert KA, Walkey AJ. Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome. J Crit Care. 2015;30:994–7.CrossRefGoogle Scholar
  18. 18.
    Carrera P, Thongprayoon C, Cheungpasitporn W, Iyer VN, Moua T. Epidemiology and outcome of new-onset atrial fibrillation in the medical intensive care unit. J Crit Care. 2016;36:102–6.CrossRefGoogle Scholar
  19. 19.
    Makrygiannis SS, Margariti A, Rizikou D, Lampakis M, Vangelis S, Ampartzidou OS, Katsifa K, Tselioti P, Foussas SG, Prekates AA. Incidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients. J Crit Care. 2014;29:697.e1-5.CrossRefGoogle Scholar
  20. 20.
    Giralt-Steinhauer E, Cuadrado-Godia E, Soriano-Tárraga C, Ois Á, Jiménez-Conde J, Rodríguez-Campello A, Gómez-González A, Muiño-Acuña E, Subirana-Cachinero I, Roquer J. New-onset paroxysmal atrial fibrillation diagnosis in ischemic stroke patients. Eur Neurol. 2015;74:211–7.CrossRefGoogle Scholar
  21. 21.
    Dewar RI, Lip GY, Guidelines Development Group for the NICE clinical guideline for the management of atrial fibrillation. Identification, diagnosis and assessment of atrial fibrillation. Heart. 2007;93:25–8.CrossRefGoogle Scholar
  22. 22.
    Liu WC, Lin WY, Lin CS, Huang HB, Lin TC, Cheng SM, Yang SP, Lin JC, Lin WS. Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation. Crit Care. 2016;20:373.CrossRefGoogle Scholar
  23. 23.
    Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–33.CrossRefGoogle Scholar
  24. 24.
    Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, Ailawadi G, Kirkwood KA, Perrault LP, Parides MK, Smith RL, Kern JA, Dussault G, Hackmann AE, Jeffries NO, Miller MA, Taddei-Peters WC, Rose EA, Weisel RD, Williams DL, Mangusan RF, Argenziano M, Moquete EG, O’Sullivan KL, Pellerin M, Shah KJ, Gammie JS, Mayer ML, Voisine P, Gelijns AC, O’Gara PT, Mack MJ, CTSN. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med. 2016;374:1911–21.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
  2. 2.Intensive Care Unit, Department of AnesthesiologyThe Jikei University School of MedicineTokyoJapan
  3. 3.Epidemiology and Preventive MedicineGraduate School of Medicine Kyoto UniversityKyotoJapan

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