PURPOSE: To describe incidence of paroxysmal atrial fibrillation (PAF) and assess risk factors for development PAF in patients admitted to ICU for sepsis.
METHODS: In this retrospective study, we prospectively identified patients with sepsis admitted to a mixed (surgical and medical) 24-bed ICU. We retrieved the following data from the electronic medical records: demographics, severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III prognostic model, comorbidities, development and treatment of PAF, complications and mortality. We calculated odds ratio (OR) and 95% confidence interval (CI) when appropriate. P values less than 0.05 were considered significant.
RESULTS: Excluding patients who did not authorize research and those with chronic atrial fibrillation (A fib), we included 86 patients in the study. Patients’ mean (SD) age was 58.9 (14.2) years and 48 (56%) were male. Twenty six patients (30%) developed PAF. Old age, coronary artery disease, history of atrial fibrillation and low ejection fraction were risk factors for PAF. The duration of the atrial fibrillation was longer than 48 hours in 13 (50%). Only two (15%) of these 13 received anticoagulation therapy. None of the 13 had a stroke. Treatment for the PAF included none in 6 (23%), rate control in 14 (54%), electrical and chemical cardioversion each in 3 (12%). The APACHE III predicted mortality rate was 49.8% and the observed 28-day mortality rate was 34.9% (30/86). Logistic regression model including PAF and APACHE III predicted mortality rate showed that PAF is not independently associated with 28-day mortality, OR with 95% CI 1.04 (0.38 –2.81) (P = 0.9373).
CONCLUSION: PAF is common in patients with sepsis. The risk factors for PAF include old age, low ejection fraction, history of PAF and coronary artery disease. The development of PAF in patients with sepsis does not increase the risk of 28-day mortality.
CLINICAL IMPLICATIONS: Patients with sepsis should be monitored for PAF, especially if the have low ejection fraction, coronary artery disease, previous history of atrial fibrillation and old age.
DISCLOSURE: Salam Salman, None.