超越节律:脓毒症中心房颤动的多方面综述:危险因素、管理策略及经济影响

Beyond the Beat: A Multifaceted Review of Atrial Fibrillation in Sepsis: Risk Factors, Management Strategies, and Economic Impact.

作者信息

Ho Wing Lam, Umais Muhammad, Bai Meena, Dang Ngoc Bao, Kumari Kajal, Izhar Sara, Asrar Rabia, Haddad Toleen, Muzammil Muhammad Ali

机构信息

St George's University School of Medicine, West Indies, Grenada.

King Edward Medical University, Lahore, Pakistan.

出版信息

Cardiol Res. 2025 Feb;16(1):1-14. doi: 10.14740/cr1723. Epub 2024 Dec 31.

Abstract

Atrial fibrillation (AF) is a common arrhythmia in critically ill patients. The objective of this narrative review is to evaluate the characteristics of patients who develop new-onset atrial fibrillation (NOAF) because of sepsis, current management of NOAF in sepsis patients, special consideration in different populations that developed NOAF, health economic and quality of life of patients. We conducted a literature search on PubMed to find research related to NOAF, sepsis and critical illness. Nineteen studies were analyzed for risk factors and outcomes. The incidence rate ranges from 0.53% to 43.9% among these studies. There were numerous risk factors that had been reported from these articles. The most reported risk factors included advanced age, male sex, White race, and cardiovascular comorbidities. The management of septic patients is significantly challenging because of the unfavorable cardiovascular consequences and thromboembolic hazards associated with NOAF. There are comprehensive guidelines available for managing AF, but the effectiveness and safety of therapies in patients with sepsis are still uncertain. Various approaches for managing newly diagnosed AF have been explored. Sinus rhythm can be restored through either pharmacological or non-pharmacological intervention or combination of both. In addition, thromboembolism is a complication that can occur in patients with AF and can have a negative impact on the prognosis of sepsis patients. The use of anticoagulation to prevent stroke after NOAF in sepsis patients is still controversial. Extensive prospective investigations are required to have a deeper understanding of the necessity for anticoagulation following NOAF in sepsis. Beside the treatment of NOAF, early detection of NOAF in sepsis plays a critical role. The prompt initiation of rhythm control medication following a clinical diagnosis of AF can enhance cardiovascular outcomes and reduce mortality in patients with AF and cardiovascular risk factors. Additionally, NOAF in the intensive care unit can prolong hospital stays, increasing hospitalization costs and burdening the hospital. Therefore, preventing and managing NOAF effectively not only benefit the patients but also the hospital in financial aspect. Lastly, to address the existing gaps in knowledge, future research should focus on developing machine learning models that can accurately anticipate risks, establish long-term follow-up protocols, and create complete monitoring systems. The focus is on early intervention and personalized approaches to improve outcomes and quality of life.

摘要

心房颤动(AF)是危重症患者中常见的心律失常。本叙述性综述的目的是评估因脓毒症而发生新发心房颤动(NOAF)的患者特征、脓毒症患者中NOAF的当前管理、发生NOAF的不同人群的特殊考虑因素、患者的健康经济状况和生活质量。我们在PubMed上进行了文献检索,以查找与NOAF、脓毒症和危重症相关的研究。分析了19项研究的危险因素和结果。这些研究中的发病率范围为0.53%至43.9%。这些文章报道了众多危险因素。报道最多的危险因素包括高龄、男性、白种人和心血管合并症。由于与NOAF相关的不良心血管后果和血栓栓塞风险,脓毒症患者的管理极具挑战性。有用于管理房颤的综合指南,但脓毒症患者治疗的有效性和安全性仍不确定。已探索了多种管理新诊断房颤的方法,可以通过药物或非药物干预或两者结合来恢复窦性心律。此外,血栓栓塞是房颤患者可能发生的并发症,可能对脓毒症患者的预后产生负面影响。脓毒症患者NOAF后使用抗凝剂预防中风仍存在争议。需要进行广泛的前瞻性研究,以更深入地了解脓毒症患者NOAF后抗凝的必要性。除了治疗NOAF,脓毒症中NOAF的早期检测也起着关键作用。房颤临床诊断后迅速开始节律控制药物治疗可改善心血管结局并降低房颤和心血管危险因素患者的死亡率。此外,重症监护病房中的NOAF会延长住院时间,增加住院费用并给医院带来负担。因此,有效预防和管理NOAF不仅有利于患者,在经济方面也有利于医院。最后,为了弥补现有知识空白,未来的研究应专注于开发能够准确预测风险的机器学习模型、建立长期随访方案并创建完整的监测系统。重点是早期干预和个性化方法,以改善结局和生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/77dd/11779681/01c1b8d88c40/cr-16-001-g001.jpg

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