title: Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome.
abstract: OBJECTIVE
  Outcomes and risk factors associated with new-onset atrial fibrillation (AF) during acute respiratory distress syndrome (ARDS) are unclear. We investigated mortality and risk factors associated with new-onset AF during ARDS.
  
  
  METHODS
  We obtained data from the ARDS Network Albuterol for Treatment of Acute Lung Injury trial, which prospectively identified new-onset AF among patients with ARDS as an adverse event. We determined Acute Physiology and Chronic Health Evaluation III-adjusted associations between new-onset AF and 90-day mortality. We also examined associations between new-onset AF and markers of inflammation (interleukin 6 and interleukin 8), myocardial injury (troponin I), autonomic activation (epinephrine), and atrial stretch (central venous pressure) as well as other clinical characteristics.
  
  
  RESULTS
  Of 282 patients (mean age, 51.6 years; 45% women; 77% white) enrolled in Albuterol for Treatment of Acute Lung Injury, 28 (10%) developed new-onset AF during the study. We did not identify associations between new-onset AF and baseline central venous pressure, plasma levels of troponin I, epinephrine, interleukin 6, or interleukin 8. New-onset AF during ARDS was associated with increased 90-day mortality (new-onset AF, 43% vs no new-onset AF, 19%; Acute Physiology and Chronic Health Evaluation-adjusted odds ratio, 3.09 [95% confidence interval, 1.24-7.72]; P = .02).
  
  
  CONCLUSIONS
  New-onset AF during ARDS is associated with increased mortality; however, its mechanisms require further study.
authors.affiliation: Department of Internal Medicine, Section of Hospital Medicine, Umass Memorial Medical Center, 119 Belmont St, Worcester, MA, 01566; Department of Medicine, Division of General Internal Medicine, Boston University School of Medicine, 800 Massachusetts Ave, Boston, MA, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ambrus
authors.affiliation: Department of Medicine, Section of Cardiovascular Medicine and Preventive Medicine, Boston University School of Medicine, 88 East Concord St, Boston, MA 02118.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, 55 Fruit St Boston MA.
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, 55 Fruit St Boston MA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Hibbert
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, The Pulmonary Center, Boston University School of Medicine, R-304, 72 East Concord St, Boston, MA, USA. Electronic address: alwalkey@bu.edu.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
mesh_terms: D000368:Aged; D000420:Albuterol / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001993:Bronchodilator Agents; C508606:CXCL8 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D000420:Albuterol
keywords: Acute respiratory distress syndrome; Atrial fibrillation; Epinephrine; Interleukins; Mechanism; Mortality; Troponin