High-Sensitivity Estimate of the Incidence of New-Onset Atrial Fibrillation in Critically Ill Patients

William F. McIntyre, MD; Emilie P. Belley-Côté, MD, PHD; Maria E. Vadakken; Anand S. Rai, BHSc; Alexandra P. Lengyel, BHSc; Bram Rochwerg, MD, MSc; Akash K. Bhatnagar, MD; Bishoy Deif, MD; Kevin J. Um, MD; Jessica Spence, MD, PhD; Stuart J. Connolly, MD, MSc; Shrikant I. Bangdiwala, PhD; Purnima Rao-Melacini, MSc; Jeff S. Healey, MD, MSc; Richard P. Whitlock, MD, PhD

doi:10.1097/CCE.0000000000000311

Critical Care Explorations (Jan 2021)

High-Sensitivity Estimate of the Incidence of New-Onset Atrial Fibrillation in Critically Ill Patients

William F. McIntyre, MD,
Emilie P. Belley-Côté, MD, PHD,
Maria E. Vadakken,
Anand S. Rai, BHSc,
Alexandra P. Lengyel, BHSc,
Bram Rochwerg, MD, MSc,
Akash K. Bhatnagar, MD,
Bishoy Deif, MD,
Kevin J. Um, MD,
Jessica Spence, MD, PhD,
Stuart J. Connolly, MD, MSc,
Shrikant I. Bangdiwala, PhD,
Purnima Rao-Melacini, MSc,
Jeff S. Healey, MD, MSc,
Richard P. Whitlock, MD, PhD

Affiliations

William F. McIntyre, MD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Emilie P. Belley-Côté, MD, PHD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Maria E. Vadakken: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Anand S. Rai, BHSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Alexandra P. Lengyel, BHSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Bram Rochwerg, MD, MSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Akash K. Bhatnagar, MD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Bishoy Deif, MD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Kevin J. Um, MD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Jessica Spence, MD, PhD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Stuart J. Connolly, MD, MSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Shrikant I. Bangdiwala, PhD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Purnima Rao-Melacini, MSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Jeff S. Healey, MD, MSc: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Richard P. Whitlock, MD, PhD: 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada.

DOI: https://doi.org/10.1097/CCE.0000000000000311
Journal volume & issue: Vol. 3, no. 1
p. e0311

Abstract

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Objective:. To estimate the incidence of new-onset atrial fibrillation in critically ill patients. Design:. Prospective cohort. Setting:. Medical-surgical ICU. Subjects:. Consecutive patients without a history of atrial fibrillation but with atrial fibrillation risk factors. Interventions:. Electrocardiogram patch monitor until discharge from hospital or up to 14 days. Measurements and Main Results:. A total of 249 participants (median age of 71 yr [interquartile range] 64–78 yr; 35% female) completed the study protocol of which 158 (64%) were admitted to ICU for medical illness, 78 (31%) following noncardiac surgery, and 13 (5%) with trauma. Median Acute Physiology and Chronic Health Evaluation II score was 16 (interquartile range, 12–22). Median duration of patch electrocardiogram monitoring, ICU, and hospital lengths of stay were 6 (interquartile range, 3–12), 4 (interquartile range, 2–8), and 11 days (interquartile range, 5–23 d), respectively. Atrial fibrillation ≥ 30 seconds was detected by the patch in 44 participants (17.7%), and three participants (1.2%) had atrial fibrillation detected clinically after patch removal, resulting in an overall atrial fibrillation incidence of 18.9% (95% CI, 14.2–24.3%). Total duration of atrial fibrillation ranged from 53 seconds to the entire monitoring time. The proportion of participants with ≥1 episode(s) of ≥6 minute, ≥1 hour, ≥12 hour and ≥24 hour duration was 14.8%, 13.2%, 7.0%, and 5.3%, respectively. The clinical team recognized only 70% of atrial fibrillation cases that were detected by the electrocardiogram patch. Conclusions:. Among patients admitted to an ICU, the incidence of new-onset atrial fibrillation is approximately one in five, although approximately one-third of cases are not recognized by the clinical team.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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