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Observational Study
. 2015 May 12;10(5):e0127168.
doi: 10.1371/journal.pone.0127168. eCollection 2015.

Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring

Charles Guenancia  1 , Christine Binquet  2 , Gabriel Laurent  3 , Sandrine Vinault  4 , Rémi Bruyère  5 , Sébastien Prin  5 , Arnaud Pavon  6 , Pierre-Emmanuel Charles  5 , Jean-Pierre Quenot  7
Affiliations
Observational Study

Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring

Charles Guenancia et al. PLoS One. .

Abstract

Purpose: We investigated incidence, risk factors for new-onset atrial fibrillation (NAF), and prognostic impact during septic shock in medical Intensive Care Unit (ICU) patients.

Methods: Prospective, observational study in a university hospital. Consecutive patients from 03/2011 to 05/2013 with septic shock were eligible. Exclusion criteria were age <18 years, history of AF, transfer with prior septic shock. Included patients were equipped with long-duration (7 days) Holter ECG monitoring. NAF was defined as an AF episode lasting >30 seconds. Patient characteristics, infection criteria, cardiovascular parameters, severity of illness, support therapies were recorded.

Results: Among 66 patients, 29(44%) developed NAF; 10 (34%) would not have been diagnosed without Holter ECG monitoring. NAF patients were older, with more markers of heart failure (troponin and NT-pro-BNP), lower left ventricular ejection fraction (LVEF), longer QRS duration and more nonsustained supra ventricular arrhythmias (<30s) on day 1 than patients who maintained sinus rhythm. By multivariate analysis, age (OR: 1.06; p = 0.01) and LVEF<45% (OR: 13.01, p = 0.03) were associated with NAF. NAF did not predict 28 or 90 day mortality.

Conclusions: NAF is common, especially in older patients, and is associated with low ejection fraction. We did not find NAF to be independently associated with higher mortality.

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Conflict of interest statement

Competing Interests: The Holter devices were provided by Sorin Group France for the duration of the study without any compensation or restriction. The Sorin Group had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The material free loan did not imply any competing interest for all authors. Thus, the authors' consider there is no relevant conflict of interest. This does not alter the authors' adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Probability of new-onset AF during the 7 first days of septic shock (Kaplan-Meier curve).
See this image and copyright information in PMC

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