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

Wen Cheng Liu, Wen Yu Lin, Chin Sheng Lin, Han Bin Huang, Tzu Chiao Lin, Shu Meng Cheng, Shih Ping Yang, Jung Chung Lin, Wei Shiang Lin, Wen Cheng Liu, Wen Yu Lin, Chin Sheng Lin, Han Bin Huang, Tzu Chiao Lin, Shu Meng Cheng, Shih Ping Yang, Jung Chung Lin, Wei Shiang Lin

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.

Keywords: Mortality; New-onset atrial fibrillation; Sepsis.

Figures

Fig. 1
Fig. 1
Patients with sepsis were enrolled and categorized into groups based on the occurrence of atrial fibrillation (AF) and AF status during ICU stay from January 2011 to January 2014. ECG electrocardiogram, SR sinus rhythm, NeOAF new-onset atrial fibrillation
Fig. 2
Fig. 2
In-hospital mortality in patients with sepsis and different AF status. NeOAF new-onset atrial fibrillation, AF atrial fibrillation, SR sinus rhythm

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