Gupta Sophie, Schnaubelt Sebastian, Oppenauer Julia, Lutnik Martin, Cacioppo Filippo, Spiel Alexander, Domanovits Hans, Sulzgruber Patrick, Niederdöckl Jan
Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Emergency Medical Service Vienna, Vienna, Austria.
Sci Rep. 2025 Jan 7;15(1):1089. doi: 10.1038/s41598-025-85224-7.
In critically ill patients with atrial fibrillation (AF), standard treatment algorithms might not be applicable. Emergency departments (ED) play a crucial role in implementing individualized treatment approaches. The aim of this study was to assess the association of lactate and cardioversion success rates in AF patients presenting to an ED. This was a retrospective single-center study analyzing 3535 AF episodes between 2012 and 2022. The main outcome was cardioversion (CV) to sinus rhythm (SR) depending on serum lactate levels (mmol/L). Lactate levels were divided into quintiles (lac < 1.1, 1.1-1.3, 1.4-1.7, 1.8-2.3 and > 2.3 mmol/L). Overall CV success declined with rising lactate levels (SR: lac < 1.1 79% (n = 547), 1.1-1.3 76% (n = 579), 1.4-1.7 73% (n = 562), 1.8-2.3 66% (n = 447), > 2.3 mmol/L 61% (n = 393); p < 0.001). Electrical CV (eCV) was conducted in 1021 (SR 95%), medical CV (mCV) in 706 (SR: 72%), facilitated CV in 523 (SR: 88%) and spontaneous conversion was observed in 591 (46% of all patients without treatment) cases. ECV was effective independent of lactate levels (SR: lac < 1.1 96% (n = 225), 1.1-1.3 93% (n = 253), 1.4-1.7 97% (n = 228), 1.8-2.3 92% (n = 154), > 2.3 mmol/L 95% (n = 106); p = 0.716). However, for mCV, conversion success decreased with increasing lactate levels (SR: lac < 1.1 84% (n = 95), 1.1-1.3 80% (n = 109), 1.4-1.7 75% (n = 115), 1.8-2.3 67% (n = 93), > 2.3 mmol/L 59% (n = 97); p < 0.001). Overall cardioversion success was less likely with rising lactate levels; especially medical cardioversion success rates decreased. Therefore, AF in critically ill may benefit from either electrical cardioversion, treatment of the underlying condition, or primary rate control.
在患有心房颤动（AF）的重症患者中，标准治疗方案可能并不适用。急诊科（ED）在实施个体化治疗方法方面发挥着关键作用。本研究的目的是评估就诊于急诊科的AF患者中乳酸水平与复律成功率之间的关联。这是一项回顾性单中心研究，分析了2012年至2022年间的3535次AF发作。主要结局是根据血清乳酸水平（mmol/L）复律（CV）至窦性心律（SR）。乳酸水平分为五分位数（lac＜1.1、1.1 - 1.3、1.4 - 1.7、1.8 - 2.3和＞2.3 mmol/L）。总体复律成功率随着乳酸水平升高而下降（SR：lac＜1.1为79%（n = 547），1.1 - 1.3为76%（n = 579），1.4 - 1.7为73%（n = 562），1.8 - 2.3为66%（n = 447），＞2.3 mmol/L为61%（n = 393）；p＜0.001）。进行了1021次电复律（eCV）（SR为95%），706次药物复律（mCV）（SR：72%），523次辅助复律（SR：88%），并在591例（所有未治疗患者的46%）中观察到自发转复。电复律的有效性与乳酸水平无关（SR：lac＜1.1为96%（n = 225），1.1 - 1.3为93%（n = 253），1.4 - 1.7为97%（n = 228），1.8 - 2.3为92%（n = 154），＞2.3 mmol/L为95%（n = 106）；p = 0.716）。然而，对于药物复律，随着乳酸水平升高，转复成功率降低（SR：lac＜1.1为84%（n = 95），1.1 - 1.3为80%（n = 109），1.4 - 1.7为75%（n = 115），1.8 - 2.3为67%（n = 93），＞2.3 mmol/L为59%（n = 97）；p＜0.001）。总体复律成功率随着乳酸水平升高而降低的可能性更大；尤其是药物复律成功率下降。因此，重症患者的AF可能受益于电复律、基础疾病的治疗或主要的心率控制。
