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. 2021 Jan 8;3(1):e0311.
doi: 10.1097/CCE.0000000000000311. eCollection 2021 Jan.

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

William F McIntyre  1   2   3 , Emilie P Belley-Côté  1   2 , Maria E Vadakken  1 , Anand S Rai  1 , Alexandra P Lengyel  1   4 , Bram Rochwerg  1   2   3 , Akash K Bhatnagar  1 , Bishoy Deif  1 , Kevin J Um  1   3 , Jessica Spence  1   3 , Stuart J Connolly  1   2   3 , Shrikant I Bangdiwala  1   3 , Purnima Rao-Melacini  1 , Jeff S Healey  1   2   3 , Richard P Whitlock  1   2   5
Affiliations

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

William F McIntyre et al. Crit Care Explor. .

Abstract

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.

Keywords: atrial fibrillation; continuous monitoring; critical illness; postoperative; secondary.

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Conflict of interest statement

Dr. McIntyre is supported by personnel awards from Canadian Stroke Prevention Intervention Network and the Canadian Institutes for Health Research (CIHR). Dr. Spence is supported by a personnel award from CIHR. Dr. Belley-Côté is supported by a personnel award from the McMaster University Department of Medicine. Dr. Whitlock is supported by a mid-career award from the Heart and Stroke Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Patient flow in the atrial fibrillation (AF) occurring transiently with stress incidence study. CHADS2 = Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, and Stroke/transient ischemic attack (2 points), OSA = obstructive sleep apnea.
See this image and copyright information in PMC

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