Skip to main content

Advertisement

SpringerLink
Log in

Arrhythmias in Critically Ill Surgical and Non-surgical Patients: A National Propensity-Matched Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Arrhythmias are common in critically ill patients, though the impact of arrhythmias on surgical patients is not well delineated. We aimed to characterize mortality following arrhythmias in critically ill patients.

Methods

We performed a propensity-matched retrospective analysis of intensive care unit (ICU) patients from 2007 to 2017 in the Cerner Acute Physiology and Chronic Health Evaluation database. We compared outcomes between patients with and without arrhythmias and those with and without surgical indications for ICU admission. We also modeled predictors of arrhythmias in surgical patients.

Results

467,951 patients were included; 97,958 (20.9%) were surgical patients. Arrhythmias occurred in 1.4% of the study cohorts. Predictors of arrhythmias in surgical patients included a history of cardiovascular disease (odds ratio [OR] 1.35, 95% confidence interval [CI95] 1.11–1.63), respiratory failure (OR 1.48, CI95 1.12–1.96), pneumonia (OR 3.17, CI95 1.98–5.10), higher bicarbonate level (OR 1.03, CI95 1.01–1.05), lower albumin level (OR 0.79, CI95 0.68–0.91), and vasopressor requirement (OR 27.2, CI95 22.0–33.7). After propensity matching, surgical patients with arrhythmias had a 42% mortality risk reduction compared to non-surgical patients (risk ratio [RR] 0.58, CI 95 0.43–0.79). Predicted probabilities of mortality for surgical patients were lower at all ages.

Conclusions

Surgical patients with arrhythmias are at lower risk of mortality than non-surgical patients. In this propensity-matched analysis, predictors of arrhythmias in critically ill surgical patients included a history of cardiovascular disease, respiratory complications, increased bicarbonate levels, decreased albumin levels, and vasopressor requirement. These findings highlight the differential effect of arrhythmias on different cohorts of critically ill populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Reinelt P, Karth GD, Geppert A et al (2001) Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU. Intensive Care Med 27(9):1466–1473

    Article  CAS  PubMed  Google Scholar 

  2. Annane D, Sebille V, Duboc D et al (2008) Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Respir Crit Care Med 178(1):20–25

    Article  PubMed  Google Scholar 

  3. Wong DT, Cheng D, Kustra R et al (1999) Risk factors of delayed extubation, prolonged length of stay in the intensive care unit, and mortality in patients undergoing coronary artery bypass graft with fast-track cardiac anesthesia. Anesthesiology 91:936–944

    Article  CAS  PubMed  Google Scholar 

  4. Tse G (2016) Mechanisms of cardiac arrhythmias. J Arrhythm 32(2):75–81

    Article  PubMed  Google Scholar 

  5. Antzelevitch C, Burashnikov A (2011) Overview of basic mechanisms of cardiac arrhythmia. Card Electrophysiol Clin 3(1):23–45

    Article  PubMed  PubMed Central  Google Scholar 

  6. Coumel P (1989) Classification of human arrhythmias. In: Vaughan Williams EM (ed) Antiarrhythmic drugs. Handbook of experimental pharmacology, vol 89. Springer, Berlin Heidelberg

    Google Scholar 

  7. Chung MK, Martin DO, Sprecher D et al (2001) C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104:2886–3289

    Article  CAS  PubMed  Google Scholar 

  8. Kanji S, Williamson DR, Yaghchi BM, et al. Canadian Critical Care Trials Group (2012) Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients. J Crit Care, 27(3):326.e1–326.e3268

  9. Echahidi N, Pibarot P, O’Hara G et al (2008) Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 51(8):793–801

    Article  CAS  PubMed  Google Scholar 

  10. Gillinov AM, Bagiella E, Moskowitz AJ et al (2016) Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med 374(20):1911–1921

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ganguly S, Brown T, Pritchett C et al (2015) Atrial fibrillation in intensive care. Intensive Care Med Exp 3(Suppl 1):A209

    Article  PubMed Central  Google Scholar 

  12. Guenancia C, Binquet C, Laurent G et al (2015) Incidence and predictors of new-onset atrial fibrillation in septic shock patients in a medical ICU: data from 7-day holter ECG monitoring. PLoS ONE 10(5):e0127168

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zimmerman JE, Kramer AA, McNair DS et al (2006) Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med 34(5):1297–1310

    Article  PubMed  Google Scholar 

  14. Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100(6):1619–1636

    Article  CAS  PubMed  Google Scholar 

  15. Dobrev D, Aguilar M, Heijman J et al (2019) Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 16(7):417–436

    Article  PubMed  Google Scholar 

  16. Wetterslev M, Hylander Møller M, Granholm A et al (2023) Atrial fibrillation (AFIB) in the ICU: incidence, risk factors, and outcomes: the international AFIB-ICU cohort study. Crit Care Med. https://doi.org/10.1097/CCM.0000000000005883

    Article  PubMed  Google Scholar 

  17. Arrigo M, Ishihara S, Feliot E et al (2018) New-onset atrial fibrillation in critically ill patients and its association with mortality: a report from the FROG-ICU study. Int J Cardiol 266:95–99

    Article  PubMed  Google Scholar 

  18. Meierhenrich R, Steinhilber E, Eggermann C et al (2010) Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study. Crit Care 14(3):R108

    Article  PubMed  PubMed Central  Google Scholar 

  19. Healey JS, Connolly SJ, Gold MR, et al. (2012) Subclinical atrial fibrillation and the risk of stroke [published correction appears in N Engl J Med. 2016 Mar 10;374(10):998]. N Engl J Med, 366(2):120–129.

  20. Valderrábano RJ, Blanco A, Santiago-Rodriguez EJ et al (2016) Risk factors and clinical outcomes of arrhythmias in the medical intensive care unit. J Intensive Care 4:9

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bosch NA, Cimini J, Walkey AJ (2018) Atrial fibrillation in the ICU. Chest 154(6):1424–1434

    Article  PubMed  PubMed Central  Google Scholar 

  22. Christian SA, Schorr C, Ferchau L et al (2008) Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. J Crit Care 23(4):532–536

    Article  PubMed  Google Scholar 

  23. Walkey AJ, Wiener RS, Ghobrial JM et al (2011) Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA 306(20):2248–2254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bruins P, te Velthuis H, Yazdanbakhsh AP et al (1997) Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96(10):3542–3548

    Article  CAS  PubMed  Google Scholar 

  25. van Beek DEC, Kuijpers YAM, Königs MHH et al (2020) Low serum albumin levels and new-onset atrial fibrillation in the ICU: a prospective cohort study. J Crit Care 56:26–30

    Article  PubMed  Google Scholar 

  26. Saliba W, Wazni OM (2011) Sinus rhythm restoration and treatment success: insight from recent clinical trials. Clin Cardiol 34(1):12–22

    Article  PubMed  PubMed Central  Google Scholar 

  27. Shahreyar M, Fahhoum R, Akinseye O et al (2018) Severe sepsis and cardiac arrhythmias. Ann Transl Med 6(1):6

    Article  PubMed  PubMed Central  Google Scholar 

  28. POISE Study Group, Devereaux PJ, Yang H et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847

    Article  Google Scholar 

  29. Bangalore S, Wetterslev J, Pranesh S et al (2008) Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet 372(9654):1962–1976

    Article  CAS  PubMed  Google Scholar 

  30. Walkey AJ, Myers LC, Thai KK et al (2023) Practice patterns and outcomes associated with anticoagulation use following sepsis hospitalizations with new-onset atrial fibrillation. Circ Cardiovasc Qual Outcomes 16(3):e009494

    Article  PubMed  Google Scholar 

  31. Rahman F, Wang N, Yin X et al (2016) Atrial flutter: clinical risk factors and adverse outcomes in the Framingham Heart Study. Heart Rhythm 13(1):233–240

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA

    Selena J. An, Jared Gallaher & Anthony Charles

  2. School of Medicine, University of North Carolina at Chapel Hill, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC, 27599, USA

    Dylane Davis

  3. Baylor College of Medicine, 1 Moursund St, Houston, TX, 77030, USA

    Sarah Peiffer

  4. Department of Surgery, University of Minnesota, 11-132 Phillips-Wangensteen Bldg., 516 Delaware Street SE, Minneapolis, MN, 55455, USA

    Christopher J. Tignanelli

  5. Department of Surgery, UNC School of Medicine, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA

    Anthony Charles

Authors
  1. Selena J. An
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dylane Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah Peiffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jared Gallaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher J. Tignanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anthony Charles
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony Charles.

Ethics declarations

Conflict of interest

None declared.

Ethical approval

This study was approved by the Institutional Review Boards at the University of North Carolina and the University of Minnesota.

Informed consent

Informed consent was waived for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

An, S.J., Davis, D., Peiffer, S. et al. Arrhythmias in Critically Ill Surgical and Non-surgical Patients: A National Propensity-Matched Study. World J Surg 47, 2668–2675 (2023). https://doi.org/10.1007/s00268-023-07129-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-023-07129-8

Search

Navigation