scholarly journals Primary success of electrical cardioversion for new-onset atrial fibrillation and its association with clinical course in non-cardiac critically ill patients: sub-analysis of a multicenter observational study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Nozomu Shima ◽  
Kyohei Miyamoto ◽  
Seiya Kato ◽  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Sinus Rhythm ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Icu Discharge ◽  
Primary Success ◽  
Success Group ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Electrical cardioversion (ECV) is widely used to restore sinus rhythm in critically ill adult patients with atrial fibrillation, although its prognostic value is uncertain. This study aims to elucidate the clinical meaning of successful ECV. Methods This is a sub-analysis of the AFTER-ICU study, a multicenter prospective study with a cohort of 423 adult non-cardiac patients with new-onset atrial fibrillation (AF). Patients that underwent ECV within 7 days after initial onset of AF were included in the sub-analysis. We compared intensive care unit (ICU) and overall hospital mortality, survival time within 30 days, cardiac rhythm at ICU discharge, and the length of ICU and overall hospital stay between patients whose sinus rhythm was restored immediately after the first ECV session (primary success group) and those in whom it was not restored (unsuccessful group). To find the factors related to the primary success of ECV, we also compared patient characteristics, the delivered energy, and pretreatment. Results Sixty-five patients received ECV and were included in this study. Although 35 patients (54%) had primary success, recurrence of AF occurred in 24 of these patients (69%). At ICU discharge, three patients still had AF in the unsuccessful group, but no patients in the primary success group still had AF. ICU mortality was 34% in the primary success group and 17% in the unsuccessful group (P = 0.10). Survival time within 30 days did not differ between the groups. Delivered energy and pretreatment were not associated with primary success of ECV. Conclusions The primary success rate of ECV for new-onset AF in adult non-cardiac ICU population was low, and even if it succeeded, the subsequent recurrence rate was high. Primary success of ECV did not affect the rate of mortality. Pretreatment and delivered energy were not associated with the primary success of ECV. Trial registration UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000026401, March 31, 2017).

scholarly journals High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

2019 ◽  
Vol 47 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Michihito Kyo ◽  
Koji Hosokawa ◽  
Shinichiro Ohshimo ◽  
Yoshiko Kida ◽  
Yuko Tanabe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Serum Potassium ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
High Serum ◽  
Factors Associated ◽  
Icu Discharge ◽  
Onset Atrial Fibrillation ◽  
New Onset

Electrical cardioversion (ECV) is a potentially life-saving treatment for haemodynamically unstable new-onset atrial fibrillation (AF); however, its efficacy is unsatisfactory. We aimed to elucidate the factors associated with successful ECV and prognosis in patients with AF. This retrospective observational study was conducted in two mixed intensive care units (ICUs) in a university hospital. Patients with new-onset AF who received ECV in the ICU were enrolled. We defined an ECV session as consecutive shocks within 15 minutes. The success of ECV was evaluated five minutes after the session. We analysed the factors associated with successful ECV and ICU mortality. Eighty-five AF patients who received ECV were included. ECV was successful in 41 (48%) patients, and 11 patients (13%) maintained sinus rhythm until ICU discharge. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV in multivariate analysis (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.07–9.11; p = 0.04). Maintenance of sinus rhythm until ICU discharge was significantly associated with ICU survival (OR 9.35; 95% CI 1.02–85.78, p = 0.048). ECV was successful in 48% of patients with new-onset AF developed in the ICU. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV, and sinus rhythm maintained until ICU discharge was independently associated with ICU survival. These results suggested that maintaining a high serum potassium level may be important when considering the effectiveness of ECV for AF in the ICU.

scholarly journals Suitability, Efficacy, and Safety of Vernakalant for New Onset Atrial Fibrillation in Critically Ill Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Alain Rudiger ◽  
Alexander Breitenstein ◽  
Mattia Arrigo ◽  
Sacha P. Salzberg ◽  
Dominique Bettex
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Sinus Rhythm ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Pressure Monitoring ◽  
Exclusion Criteria ◽  
Arterial Blood ◽  
Onset Atrial Fibrillation ◽  
New Onset

Objectives. This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF) after cardiac surgery.Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers’ recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment.Results. Of the 191 patients screened, 159 (83%) were excluded, most importantly due to hemodynamic instability (59%). Vernakalant was administered to 32 (17% of the screened) patients. Within 6 hours, 17 (53%) patients converted to sinus rhythm. Blood pressure did not decrease significantly 10, 30, 60, and 120 minutes after the vernakalant infusion. However, 11 patients (34%) experienced a transient decrease in mean arterial blood pressure <60 mmHg. Other adverse events included nausea (n=1) and bradycardia (n=2).Conclusions. Applying the strict inclusion and exclusion criteria provided by the manufacturer, only a minority of postoperative ICU patients with new onset AF qualified for vernakalant. Half of the treated patients converted to sinus rhythm. The drug was well tolerated, but close heart rate and blood pressure monitoring remains recommended.

scholarly journals ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter

2021 ◽  
Vol 8 ◽  
Author(s):  
Hailei Liu ◽  
Zhoushan Gu ◽  
Chao Zhu ◽  
Mingfang Li ◽  
Jincheng Jiao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
P Wave ◽  
Negative Component ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Electrocardiographic Parameters ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation.Methods: A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (DFNII), proportion of the DFNII of the total circle length of AFL (DFNII%), amplitude of the negative component of flutter wave in lead II (AFNII), duration (DPNV1), and amplitude (APNV1) of negative component of the P wave in lead V1, and P wave duration in lead II (DPII) during sinus rhythm were measured.Results: During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. DFNII was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, p &lt; 0.0001). AFNII was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, p &lt; 0.0001), DPII (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, p &lt; 0.0001), and DPNV1 was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, p &lt; 0.0001) in patients with new-onset AF. In the multivariate analysis, DFNII [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; p = 0.028] and DPII (OR, 1.429; 95% CI, 1.046–1.953; p = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation.Conclusion: Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.

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

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Cheng Liu ◽  
Wen Yu Lin ◽  
Chin Sheng Lin ◽  
Han Bin Huang ◽  
Tzu Chiao Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Prognostic Impact ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Predictors of time to conversion of new‐onset atrial fibrillation to sinus rhythm with amiodarone therapy

2020 ◽  
Vol 36 (4) ◽  
pp. 705-711
Author(s):  
Ihsan Dursun ◽  
Sinan Sahin ◽  
Ali Bayraktar ◽  
Omer Faruk Cirakoglu ◽  
Selim Kul ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Amiodarone Therapy ◽  
Onset Atrial Fibrillation ◽  
New Onset

P3610Prognostic implication of new-onset atrial fibrillation burden in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J C Luo ◽  
H Q Li ◽  
Z Q Li ◽  
B X Liu ◽  
M M Gong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Sinus Rhythm ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
High Burden ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) can be associated with adverse cardiovascular events. The prognostic implication of the burden of atrial fibrillation has been investigated in various settings. Purpose We aimed to explore the association of the burden of post-MI NOAF with the risk of adverse cardiovascular events during hospitalization. Methods All consecutive patients admitted forAMI between February 2014 and February 2018 were analyzed by continuous electronic monitoring (CEM) through hospitalization. AF burden was calculated by dividing the total AF duration by the total CEM duration. Patients were divided into 3 groups: sinus rhythm group, low burden (AF burden≤8.5%) group, and high burden (AF burden>8.5%) group. The primary outcome was a composite of in-hospital all-cause death, recurrent MI, acute heart failure, or cardiogenic shock. Results Overall, 2405 patients (mean age: 65.8 years; male: 76.6%) were included. NOAF was documented in 11.6% of patients, and the primary outcome was recorded in 288 patients (13.6%) of the sinus rhythm group, 42 (30.0%) in the low burden group, and 71 (50.7%) in the high burden group. Compared with patients with sinus rhythm, a greater burden of NOAF was associated with a higher risk of the primary outcome after multivariable analysis (low burden: hazard ratio, 1.22; 95% confidence interval [CI]: 0.87–1.70; high burden: hazard ratio, 1.90; 95% CI: 1.43–2.51; p for trend<0.001). In-hospital cardiovascular events MACE Patients/Events, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/288 1.00 (reference) 1.00 (reference) Low burden 140/42 2.05 (1.48–2.84) 1.22 (0.87–1.70) High burden 140/71 3.93 (3.03–5.10) 1.90 (1.43–2.51) P for trend – <0.001 <0.001 All-cause death Patients, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/106 1.00 (reference) 1.00 (reference) Low burden 140/10 1.02 (0.53–1.97) 0.52 (0.27–1.02) High burden 140/32 3.62 (2.41–5.42) 1.37 (0.89–2.09) P for trend – <0.001 0.081 aAdjusted for age, sex, current smoking, hypertension, diabetes mellitus, dyslipidemia, CKD, previous MI, previous stroke, previous heart failure, symptom onset to emergency department duration, STEMI, pre-hospital cardiac arrest, LVEF, and on-admission HR, SBP and CS, peak TnT, reperfusion therapy and GPIIb/IIIa inhibitor. Kaplan-Meier plots of in-hospital events Conclusion A greater burden of NOAF complicatingAMI was associated withan increased risks of in-hospital adverse events. Acknowledgement/Funding National Natural Science Foundation of China grant 81270193 and Natural Science Foundation of Shanghai grant 18ZR1429700

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