Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical Icu Patients

Arrigo, Mattia; Jeger, N; Seifert, B; Dr, Spahn; Béttex, Dominique; Rudiger, Alain

doi:10.1186/2197-425x-3-s1-a946

Cited by 7 publications

(11 citation statements)

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“…Second, there was no written protocol for the indication and procedures of ECV, resulting in variations in the ECV energies delivered and the number of ECVs. The delivered energy in our study tended to be lower than in a previous study, 10 which could have affected the success rate of ECV. Third, adjunctive therapies (e.g.…”

Section: Discussioncontrasting

confidence: 72%

High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

Kyo

Ohshimo

Kida

et al. 2019

Anaesth Intensive Care

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Electrical cardioversion (ECV) is a potentially life-saving treatment for haemodynamically unstable new-onset atrial fibrillation (AF); however, its efficacy is unsatisfactory. We aimed to elucidate the factors associated with successful ECV and prognosis in patients with AF. This retrospective observational study was conducted in two mixed intensive care units (ICUs) in a university hospital. Patients with new-onset AF who received ECV in the ICU were enrolled. We defined an ECV session as consecutive shocks within 15 minutes. The success of ECV was evaluated five minutes after the session. We analysed the factors associated with successful ECV and ICU mortality. Eighty-five AF patients who received ECV were included. ECV was successful in 41 (48%) patients, and 11 patients (13%) maintained sinus rhythm until ICU discharge. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV in multivariate analysis (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.07–9.11; p = 0.04). Maintenance of sinus rhythm until ICU discharge was significantly associated with ICU survival (OR 9.35; 95% CI 1.02–85.78, p = 0.048). ECV was successful in 48% of patients with new-onset AF developed in the ICU. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV, and sinus rhythm maintained until ICU discharge was independently associated with ICU survival. These results suggested that maintaining a high serum potassium level may be important when considering the effectiveness of ECV for AF in the ICU.

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Section: Discussioncontrasting

confidence: 72%

High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

Kyo

Ohshimo

Kida

et al. 2019

Anaesth Intensive Care

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“…The management of critically ill patients developing AFib is challenging. Indeed, AFib may impair the ventricular filling and precipitate acute heart failure 3-5 , on the other hand, management of AFib in ICU patients is particularly difficult, because many antiarrhythmic treatments are either contraindicated or their efficacy is reduced, predisposing to early relapses 6,15,16 . Understanding whether AFib independently contributes to worse outcome of critically ill patients or is merely a marker of disease severity is therefore of crucial importance.…”

Section: Discussionmentioning

confidence: 99%

“…Critical illness may induce the development of AFib in patients without previous history of arrhythmia (new-onset AFib) or precipitate relapses in patients with history of paroxysmal AFib (recurrent AFib). The underlying mechanisms include fluid and electrolyte imbalance, inflammation, ischemia and adrenergic overstimulation 2 , which impair efficacy of treatments and promote early relapses 6 .…”

Section: Introductionmentioning

confidence: 99%

New-onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG-ICU study

Arrigo

Ishihara

Féliot

et al. 2018

International Journal of Cardiology

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“…This difficulty was the focus of the article by Arrigo et al (10) in this issue of Critical Care Medicine, which showed that electrical cardioversion was successful in restoring sinus rhythm in only 66% of 88 cardiac surgery patients who developed AF and were hemodynamically unstable (11). In the 56 patients after aortic surgery, there was a 79% success rate.…”

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confidence: 94%

Irregularly Irregular Heartbeats Occur Regularly in the ICU*

Weissman

2015

Critical Care Medicine

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A mong the scourges that beset ICU patients are atrial fibrillation (AF) and atrial flutter, which are the most common cardiac arrhythmias found among adult ICU patients. AF can be either preexisting or of new onset. The former situation is not unexpected as the prevalence of chronic AF increases with age, rising from 0.7% in 55-to 59-year olds to 17.8% in those who are 85 years old or older (1). As of 2014, 2-3% of the European and North American population were afflicted with AF. Aging causes degenerative changes in atrial tissues, changes in atrial electrophysiology, atrial stiffening, and fragmentation of the atrial excitation waveform. Therefore, many older ICU patients have persistent or paroxysmal AF. Such patients may have reduced cardiac reserve secondary to atrial dysfunction, have increased risk of stroke, and be receiving anti-coagulation and taking medications with hemodynamic consequences. Therefore, they present a special challenge when suffering from critical illnesses and often have greater morbidity and mortality than their counterparts with normal sinus rhythm. Furthermore, AF-associated embolic strokes treated with thrombolytic or neurointerventional techniques, along with hemorrhagic complications of the anticoagulation therapy intended to prevent such strokes, often result in ICU admission.However, it is the patients who develop AF for the first time while in the ICU that constitute a special population. Patients with new-onset AF can be divided into two groups: those with and those without pathology within the chest cavity. Direct surgical, penetrating, and blunt traumas to the thorax are associated with significant incidences of AF. After thoracic and cardiac surgery, AF occurs with regularity. It occurs in 12-45% of patients after pulmonary and esophageal surgery, where, compared with patients without such arrhythmias, it is associated with more pulmonary complications, greater risk of stroke, higher mortality, longer hospital stays, and higher hospital costs. Age 60 years old or older is the most strongly associated independent variable associated with postthoracic surgery AF (2). Within 2-3 days after cardiac surgery, up to 80% of patients develop AF, with a higher frequency after valvular than coronary artery surgery. The highest incidence occurs after combined bypass and valvular procedures (60-80%). Many of these episodes of AF are self-limited to the days immediately after surgery but are associated with longer ICU and hospital lengths of stay and greater in-hospital and long-term mortality (3).New-onset AF in ICU patients without major chest cavity problems is common. In a three-center Canadian study of 3,081 medical and noncardiac surgical ICU patients, newonset AF occurred in 139 patients (4.5%) and was preexisting in 186 patients (6.0%). Hemodynamic instability developed in 37% and 10% of patients with new-onset AF and preexisting AF, respectively (4). Among 66 medical ICU patients with septic shock who underwent Holter monitoring, 29 (44%) developed new-onset AF which upon mult...

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Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical Icu Patients

Cited by 7 publications

References 0 publications

High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

New-onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG-ICU study

Irregularly Irregular Heartbeats Occur Regularly in the ICU*

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