title: Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation.
abstract: BACKGROUND
  New-onset atrial fibrillation (NeOAF) is a common type of tachyarrhythmia in critically ill patients and is associated with increased mortality in patients with sepsis. However, the prognostic impact of restored sinus rhythm (SR) in septic patients with NeOAF remains unclear.
  
  
  METHODS
  A total of 791 patients with sepsis, who were admitted to a medical intensive care unit from January 2011 to January 2014, were screened. NeOAF was detected by continuous electrocardiographic monitoring. Patients were categorized into three groups: no NeOAF, NeOAF with restored SR (NeOAF to SR), and NeOAF with failure to restore SR (NeOAF to atrial fibrillation (AF)). The endpoint of this study was in-hospital mortality. Patients with pre-existing AF were excluded.
  
  
  RESULTS
  We reviewed the data of 503 eligible patients, including 263 patients with no NeOAF and 240 patients with NeOAF. Of these 240 patients, SR was restored in 165 patients, and SR could not be restored in 75 patients. The NeOAF to AF group had the highest in-hospital mortality rate of 61.3% compared with the NeOAF to SR and no NeOAF groups (26.1% and 17.5%, respectively). Moreover, multivariate logistic regression analysis revealed that failure of restored SR was independently associated with increased in-hospital mortality in patients with sepsis and NeOAF.
  
  
  CONCLUSIONS
  Failure to restore a sinus rhythm in patients with new-onset atrial fibrillation may be associated with increased in-hospital mortality in patients with sepsis. Further prospective studies are needed to clarify the effects of restoration of sinus rhythm on survival in patients with sepsis and new-onset atrial fibrillation.
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Wen Cheng
authors.initials: WC
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Wen Yu
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Chin Sheng
authors.initials: CS
authors.lastname: Lin
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Han Bin
authors.initials: HB
authors.lastname: Huang
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Tzu Chiao
authors.initials: TC
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Shu Meng
authors.initials: SM
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
authors.forename: Shih Ping
authors.initials: SP
authors.lastname: Yang
authors.affiliation: Division of infectious Diseases and Tropical Medicine, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jung Chung
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan. wslin545@ms27.hinet.net.
authors.forename: Wei Shiang
authors.initials: WS
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology
keywords: Mortality; New-onset atrial fibrillation; Sepsis