title: Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management-Are We Giving It the Attention it Deserves?
abstract: OBJECTIVE
  Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post-cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management.
  
  
  METHODS
  A post hoc analysis of a prospective randomized trial.
  
  
  METHODS
  Thirty-six ICUs.
  
  
  METHODS
  We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010-2013) with data on heart rhythm on day 2.
  
  
  METHODS
  Targeted temperature management at 33°C or 36°C.
  
  
  RESULTS
  Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation. Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management. The cumulative proportions of atrial fibrillation were 15% and 11% on days 1 and 2, respectively. Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2. No difference was found between the groups treated with targeted temperature management at 33°C and 36°C. Patients affected by atrial fibrillation had significantly higher 180-day mortality (atrial fibrillation: 66% vs no-atrial fibrillation: 43%; plogrank < 0.0001 and unadjusted hazard ratio, 1.75 [1.35-2.30]; p < 0.0001). The association between atrial fibrillation and higher mortality remained significant (adjusted hazard ratio, 1.34 [1.01-1.79]; p < 0.05) adjusted for potential confounders. Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure (adjusted hazard ratio, 2.07 [1.39-3.09]; p < 0.001), whereas no association with higher risk of death from cerebral causes was found.
  
  
  CONCLUSIONS
  Atrial fibrillation was independently associated with higher mortality, primarily driven by cardiovascular causes and multiple-organ failure, and may thus identify a vulnerable subpopulation. Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established.
authors: 1Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Rigshospitalet, Denmark.2Department of Cardiology, Skåne University Hospital, Lund, Sweden.3Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.4Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands.5Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.6Department of Thoracic Anaesthesiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors: Jakob Hartvig
authors: JH
authors: Thomsen
authors: Christian
authors: C
authors: Hassager
authors: David
authors: D
authors: Erlinge
authors: Niklas
authors: N
authors: Nielsen
authors: Janneke
authors: J
authors: Horn
authors: Jan
authors: J
authors: Hovdenes
authors: John
authors: J
authors: Bro-Jeppesen
authors: Michael
authors: M
authors: Wanscher
authors: Steen
authors: S
authors: Pehrson
authors: Lars
authors: L
authors: Køber
authors: Jesper
authors: J
authors: Kjaergaard
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis