McIntyre William F, Belley-Côté Emilie P, Vadakken Maria E, Rai Anand S, Lengyel Alexandra P, Rochwerg Bram, Bhatnagar Akash K, Deif Bishoy, Um Kevin J, Spence Jessica, Connolly Stuart J, Bangdiwala Shrikant I, Rao-Melacini Purnima, Healey Jeff S, Whitlock Richard P
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Crit Care Explor. 2021 Jan 8;3(1):e0311. doi: 10.1097/CCE.0000000000000311. eCollection 2021 Jan.
To estimate the incidence of new-onset atrial fibrillation in critically ill patients.
Prospective cohort.
Medical-surgical ICU.
Consecutive patients without a history of atrial fibrillation but with atrial fibrillation risk factors.
Electrocardiogram patch monitor until discharge from hospital or up to 14 days.
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.
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.
评估危重症患者新发房颤的发生率。
前瞻性队列研究。
内科-外科重症监护病房。
无房颤病史但有房颤危险因素的连续患者。
使用心电图贴片监测直至出院或最长14天。
共有249名参与者（年龄中位数71岁[四分位间距]64 - 78岁；35%为女性）完成研究方案，其中158名（64%）因内科疾病入住重症监护病房，78名（31%）接受非心脏手术后入住，13名（5%）因创伤入住。急性生理与慢性健康状况评价II评分中位数为16（四分位间距，12 - 22）。贴片心电图监测的中位数时长、重症监护病房住院时长及住院总时长分别为6天（四分位间距，3 - 12天）、4天（四分位间距，2 - 8天）和11天（四分位间距，5 - 23天）。贴片检测到44名参与者（17.7%）出现持续≥30秒的房颤，3名参与者（1.2%）在移除贴片后临床检测到房颤，总体房颤发生率为18.9%（95%可信区间，14.2 - 24.3%）。房颤总时长从53秒至整个监测时间不等。持续时间≥6分钟、≥1小时、≥12小时及≥24小时的发作次数≥1次的参与者比例分别为14.8%、13.2%、7.0%和5.3%。临床团队仅识别出心电图贴片检测到的房颤病例中的70%。
在入住重症监护病房的患者中，新发房颤的发生率约为五分之一，尽管约三分之一的病例未被临床团队识别。
