The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, United States; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, United States.
Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, United States; Ohio University Heritage College of Osteopathic Medicine, United States.
Resuscitation. 2024 Aug;201:110270. doi: 10.1016/j.resuscitation.2024.110270. Epub 2024 Jun 8.
Atrial fibrillation (AF) in patients resuscitated from cardiac arrest (CA) is associated with increased short-term mortality. However, whether this is because AF adversely affects early resuscitation success, causes post-resuscitation morbidity, or because it is a marker for patient co-morbidities, remains unclear. We aimed to determine the prevalence of AF in patients with ROSC to test the hypothesis that AF is associated with increased risk of rearrest and to determine its impact on mortality and stroke risk.
We performed a retrospective study of emergency medical services patients with OHCA and ROSC. To examine long-term morbidity and mortality due to AF, an additional observational cohort analysis was performed using a large electronic health record (EHR) database.
One hundred nineteen patients with ROSC prior to ED arrival were identified. AF was observed in 39 (33%) of patients. Rearrest was not different between AF and no AF groups (44% vs. 41%, p = 0.94). In the EHR analysis, mortality at one year in patients who developed AF was 59% vs. 39% in no AF patients. Odds of stroke was 5x greater in AF patients (p < 0.001), with the majority not anticoagulated (93%, p < 0.001) and comorbidities were greater p < 0.001).
AF was common following ROSC and not associated with rearrest. AF after CA was associated with increased mortality and stroke risk. These data suggest rhythm control for AF in the immediate post-ROSC period is not warranted; however, vigilance is required for patients who develop persistent AF, particularly with regards to stroke risk and prevention.
在心脏骤停（CA）后复苏的患者中，心房颤动（AF）与短期死亡率增加有关。然而，这是因为 AF 对早期复苏成功有不利影响，导致复苏后发病率增加，还是因为它是患者合并症的标志物，目前尚不清楚。我们旨在确定接受 ROSC 的患者中 AF 的患病率，以检验 AF 与再次逮捕风险增加相关的假设，并确定其对死亡率和中风风险的影响。
我们对接受紧急医疗服务的 OHCA 和 ROSC 患者进行了回顾性研究。为了检查由于 AF 导致的长期发病率和死亡率，我们使用大型电子健康记录（EHR）数据库进行了额外的观察队列分析。
确定了 119 名在 ED 到达前出现 ROSC 的患者。在 39 名（33%）患者中观察到 AF。AF 组和无 AF 组之间的再次逮捕没有差异（44% vs. 41%，p=0.94）。在 EHR 分析中，AF 患者在一年内的死亡率为 59%，无 AF 患者的死亡率为 39%。AF 患者中风的几率高 5 倍（p<0.001），且大多数患者未接受抗凝治疗（93%，p<0.001），且合并症更多（p<0.001）。
在 ROSC 后，AF 很常见，与再次逮捕无关。CA 后 AF 与死亡率和中风风险增加相关。这些数据表明，在 ROSC 后立即进行 AF 的节律控制是不必要的；然而，需要对出现持续性 AF 的患者保持警惕，特别是在中风风险和预防方面。
