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COMMENTARY Atrial fibrillation is not just an artefact in the ICU

By Yoann Launey and Service De RĂ©animation Chirurgicale


Atrial fibrillation (AF) is common in the intensive care unit (ICU) and is particularly frequent (46%) in septic shock patients. Inflammation favours AF in the general population, and there is a growing body of evidence that inflammation also plays a role in AF occurring after cardiac surgery but also in the general ICU. How such a finding could modify the therapeutic approach remains elusive. The impact of AF on mortality is not clearly demonstrated in the ICU, with AF reflecting essentially the severity of the underlying disease. Atrial fibrillation (AF) onset in the intensive care unit (ICU) is attracting widespread attention because of its frequency and prognostic significance. In the previous issue of Critical Care, Meierhenrich and colleagues complete the description of new-onset AF in the ICU in a selected population of patients suffering from septic shock [1]. They found that 46 % of their patients developed AF and this arrhythmia was significantly associated with increased ICU length of stay without affecting mortality. Interestingly, they reported a significant and continuous increase in C-reactive protein levels the days before the occurrence of AF, corroborating previous findings on the hypothesis of an inflammatory substrate in AF onset [2]. AF is the most significant arrhythmia in the ICU. The risk to develop AF in the ICU is largely superior to that of the general population but differs with regard to the type of ICU involved. Indeed, the risk is estimated to be 4 % in the general population, from 4 to 9 % in the general ICU and an incidence of 32 % has been recently reported in a cardiac surgical ICU [3-9]. How could we explain such a difference? In fact, AF is considered both a cardiac disease and a noncardiac disease. Age, essential hypertension, ischaemic hear

Year: 2013
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