title: Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring.
abstract: OBJECTIVE
  We investigated incidence, risk factors for new-onset atrial fibrillation (NAF), and prognostic impact during septic shock in medical Intensive Care Unit (ICU) patients.
  
  
  METHODS
  Prospective, observational study in a university hospital. Consecutive patients from 03/2011 to 05/2013 with septic shock were eligible. Exclusion criteria were age <18 years, history of AF, transfer with prior septic shock. Included patients were equipped with long-duration (7 days) Holter ECG monitoring. NAF was defined as an AF episode lasting >30 seconds. Patient characteristics, infection criteria, cardiovascular parameters, severity of illness, support therapies were recorded.
  
  
  RESULTS
  Among 66 patients, 29(44%) developed NAF; 10 (34%) would not have been diagnosed without Holter ECG monitoring. NAF patients were older, with more markers of heart failure (troponin and NT-pro-BNP), lower left ventricular ejection fraction (LVEF), longer QRS duration and more nonsustained supra ventricular arrhythmias (<30s) on day 1 than patients who maintained sinus rhythm. By multivariate analysis, age (OR: 1.06; p = 0.01) and LVEF<45% (OR: 13.01, p = 0.03) were associated with NAF. NAF did not predict 28 or 90 day mortality.
  
  
  CONCLUSIONS
  NAF is common, especially in older patients, and is associated with low ejection fraction. We did not find NAF to be independently associated with higher mortality.
authors.affiliation: University Hospital, Department of Cardiology, Dijon, France; INSERM, UMR866, LPPCM, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: University Hospital, Clinical Investigation Centre, Clinical epidemiology/clinical trial unit, Dijon, France; INSERM, CIC1432, Clinical epidemiology unit, Dijon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.affiliation: University Hospital, Department of Cardiology, Dijon, France; CNRS, UMR 5158, Le2I, Dijon, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Laurent
authors.affiliation: INSERM, CIC1432, Clinical epidemiology unit, Dijon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vinault
authors.affiliation: University Hospital, Intensive Care Unit, Dijon, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Bruyère
authors.affiliation: University Hospital, Intensive Care Unit, Dijon, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Prin
authors.affiliation: INSERM, CIC1432, Clinical epidemiology unit, Dijon, France; University Hospital, Intensive Care Unit, Dijon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pavon
authors.affiliation: University Hospital, Intensive Care Unit, Dijon, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Charles
authors.affiliation: INSERM, UMR866, LPPCM, Dijon, France; INSERM, CIC1432, Clinical epidemiology unit, Dijon, France; University Hospital, Intensive Care Unit, Dijon, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*