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Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients

¹ Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique–Hôpitaux de Paris, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint-Quentin en Yvelines, Garches, France; ² Laboratoire de Biostatistiques, Faculté de Pharmacie, Université de Nantes, Nantes, France; ³ Service de Cardiologie, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Université Paris V, Paris, France; ⁴ Service de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris V, Paris, France; ⁵ Service de Cardiologie, Hôpital Brabois, Centre Hospitalier Universitaire, Université de Nancy I, Vandoeuvre Les Nancy, France; and ⁶ Centre d'Investigation Clinique INSERM 0203, Unité de Pharmacologie Clinique, Service de Pharmacologie, Hôpital de Pontchaillou, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Rennes 1, Rennes, France

Correspondence and requests for reprints should be addressed to Professor Djillali Annane, M.D., Ph.D., Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France. E-mail: djillali.annane{at}rpc.aphp.fr

Rationale: Sustained arrhythmias are common in postoperative and cardiac intensive care units (ICUs), but their incidence and prognosis in general ICUs have never been reported.

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

Methods: Prospective, multicenter, 1-month inception cohort study.

Measurements and Main 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.

Key Words: arrhythmia • critical illness • hospital mortality • neurological sequel • propensity score

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Sustained arrhythmias are common in postoperative and cardiac intensive care units (ICUs), but their incidence and prognosis in general ICUs have never been reported. What This Study Adds to the Field This study estimates a 12% prevalence of sustained arrhythmias in general ICU patients. Ventricular arrhythmias increase the risk of death, and the risk of neurological sequelae.

 

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