Incidence and prognosis of sustained arrhythmias in critically ill patients.
BACKGROUND
Sustained arrhythmias are common in postoperative and cardiac intensive care units (ICUs), but their incidence and prognosis in general ICUs have never been reported.


OBJECTIVE
To estimate the incidence and prognosis of sustained arrhythmias in a general ICU population.


METHODS
Prospective, multicenter, 1-month inception cohort study.


RESULTS
A total of 1,341 patients were included: 12% (163/1,341) had sustained arrhythmias, including 8% (113/1,341) and 2% (30/1,341) with supraventricular and ventricular arrhythmias, respectively, and 2% (30/1,341) with conduction abnormalities. In-hospital death rates were 17% (205/1,178) in patients without arrhythmia and 29% (33/113) in patients with supraventricular arrhythmias (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.27-3.01), 73% (22/30) in patients with ventricular arrhythmias (OR, 13.20; 95% CI, 5.79-30.10), and 60% (18/30) in patients with conduction abnormalities (OR, 7.46; 95% CI, 3.52-15.82). Neurological sequel rates were 6% (55/973) in arrhythmia-free survivors and 15% (12/80) in survivors with supraventricular arrhythmias (OR, 2.92; 95% CI, 1.45-5.89), 38% (3/8) in survivors with ventricular arrhythmias (OR, 7.53; 95% CI, 1.60-35.50), and 17% (2/12) in survivors with conduction abnormalities (OR, 8.77; 95% CI, 1.65-46.57). After adjusting for prognosis factors and propensity scores, ventricular arrhythmias still increased mortality (OR, 3.53; 95% CI, 1.19-10.42) but supraventricular arrhythmias and conduction abnormalities did not.


CONCLUSIONS
Sustained arrhythmias are observed in 12% of patients admitted to general ICUs. Ventricular arrhythmias increase the risk of death.
Annane
Djillali
D
Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France. djillali.annane@rpc.aphp.fr
Sébille
Véronique
V
Duboc
Denis
D
Le Heuzey
Jean-Yves
JY
Sadoul
Nicolas
N
Bouvier
Erik
E
Bellissant
Eric
E
D018806:APACHE; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors