A-fib in Sepsis Increases Mortality

Short Attention Span Summary

Restoration heart-ware
Patients with sepsis and new onset atrial fibrillation (a-fib) have a worse prognosis.  Restoring them to normal sinus rhythm (NSR) improved mortality.  Mortality was 61.3% in patients who were not converted back to NSR, 21.6% in those with new a-fib converted back to NSR, and 17.5% in those with no a-fib.  Of course, this is only an association - refractory a-fib may be a marker of sicker patients with greater mortality.  But it appears worthwhile to make an attempt to cardiovert patients with sepsis and known new-onset a-fib.

Spoon Feed
New a-fib is associated with increased mortality in sepsis patients.  These patients may benefit from restoration of normal sinus rhythm.


Abstract

Crit Care. 2016 Nov 18;20(1):373.

Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation.

Liu WC1, Lin WY1, Lin CS1, Huang HB2, Lin TC1, Cheng SM1, Yang SP1, Lin JC3, Lin WS4.

Author information:

1Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.

2School of Public Health, National Defense Medical Center, Taipei, Taiwan.

3Division of infectious Diseases and Tropical Medicine, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

4Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan. wslin545@ms27.hinet.net.

Abstract

BACKGROUND:

New-onset atrial fibrillation (NeOAF) is a common type of tachyarrhythmia in critically ill patients and is associated with increased mortality in patients with sepsis. However, the prognostic impact of restored sinus rhythm (SR) in septic patients with NeOAF remains unclear.

METHODS:

A total of 791 patients with sepsis, who were admitted to a medical intensive care unit from January 2011 to January 2014, were screened. NeOAF was detected by continuous electrocardiographic monitoring. Patients were categorized into three groups: no NeOAF, NeOAF with restored SR (NeOAF to SR), and NeOAF with failure to restore SR (NeOAF to atrial fibrillation (AF)). The endpoint of this study was in-hospital mortality. Patients with pre-existing AF were excluded.

RESULTS:

We reviewed the data of 503 eligible patients, including 263 patients with no NeOAF and 240 patients with NeOAF. Of these 240 patients, SR was restored in 165 patients, and SR could not be restored in 75 patients. The NeOAF to AF group had the highest in-hospital mortality rate of 61.3% compared with the NeOAF to SR and no NeOAF groups (26.1% and 17.5%, respectively). Moreover, multivariate logistic regression analysis revealed that failure of restored SR was independently associated with increased in-hospital mortality in patients with sepsis and NeOAF.

CONCLUSIONS:

Failure to restore a sinus rhythm in patients with new-onset atrial fibrillation may be associated with increased in-hospital mortality in patients with sepsis. Further prospective studies are needed to clarify the effects of restoration of sinus rhythm on survival in patients with sepsis and new-onset atrial fibrillation.

PMCID: PMC5114755 Free PMC Article

PMID: 27855722 [PubMed - in process]