Triggers of Atrial Fibrillation in the Geriatric Medical Intensive Care Unit: An Observational Study

Background Atrial fibrillation (AF) is a common arrhythmia in the non-cardiac intensive care unit (ICU). However, data concerning AF incidence and predictors in such populations are scarce and controversial. The study aimed to investigate the contributing factors of new-onset AF in elderly patients within the medical intensive care setting. Methods Patients admitted to ICU during a 6-month period were prospectively studied. Patients admitted for short period postoperative monitoring and patients with chronic or paroxysmal AF were excluded. The conditions involved as AF risk factors or “triggers” from demographic data, history, and echocardiography were recorded. Acute Physiology and Chronic Health Evaluation II score was calculated. Electrolytes including some trace elements (zinc, copper, and magnesium) were analyzed. Results The study included 142 patients (49% females). Mean age was 69.5 ± 7.3 years. AF was observed in 12%. Diagnosis of pneumonia (P < 0.001), low copper (P < 0.0001) and low zinc levels (P < 0.0001) was significantly associated with the occurrence of AF. By multivariate analysis, they remained statistically significant (odds ratio, 7.0; 95% confidence interval, 2.0 - 24.6; P < 0.01). Conclusions A significant fraction of ICU elderly patients manifests AF. The relevant factors contributing to AF incidence in the elderly are pneumonia and low zinc and low copper.

[1]  Stephanie B Edwin,et al.  Vasopressor and Inotropic Management Of Patients With Septic Shock. , 2015, P & T : a peer-reviewed journal for formulary management.

[2]  O. Cremer,et al.  Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review , 2014, Critical Care.

[3]  M. Ezekowitz,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. , 2014, Circulation.

[4]  A. Prasad.  Zinc: an antioxidant and anti-inflammatory agent: role of zinc in degenerative disorders of aging. , 2014, Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements.

[5]  A. Penev,et al.  Paroxysmal Atrial Fibrillation: Dynamics of The Main Antioxidant Enzymes - Superoxide Dismutase and Catalase , 2014, Folia medica.

[6]  D. Bettex,et al.  Management of Atrial Fibrillation in Critically Ill Patients , 2014, Critical care research and practice.

[7]  A. A. Alexandrova,et al.  Assessment of Copper Status in Patients with Paroxysmal Atrial Fibrillation Keywords: Paroxysmal atrial fibrillation; Copper status; Copper , 2014 .

[8]  Kai-Chien Yang,et al.  Oxidative stress and atrial fibrillation: finding a missing piece to the puzzle. , 2013, Circulation.

[9]  Jenny X. Sun,et al.  Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study , 2013, Circulation.

[10]  Abstracts from the 26th National Congress of the Italian Society of Geriatric Surgery, 19-22 June 2013, Naples, Italy. , 2013, BMC surgery.

[11]  Xiao-cheng Liu,et al.  Alterations of Zinc, Copper, and Magnesium Concentrations During and After Open Heart Surgery , 2012 .

[12]  L. Zou,et al.  Relation Between Zinc, Copper, and Magnesium Concentrations Following Cardiopulmonary Bypass and Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting , 2012, Biological Trace Element Research.

[13]  E. Benjamin,et al.  Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. , 2011, JAMA.

[14]  S. Baldus,et al.  Inflammatory pathways underlying atrial fibrillation. , 2011, Trends in molecular medicine.

[15]  Y. Launey,et al.  Atrial fibrillation is not just an artefact in the ICU , 2010, Critical care.

[16]  M. Georgieff,et al.  Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study , 2010, Critical care.

[17]  R. Califf,et al.  Patterns of management of atrial fibrillation complicating coronary artery bypass grafting: Results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT-IV) Trial. , 2009, American heart journal.

[18]  B. Hedblad,et al.  Inflammation-sensitive plasma proteins are associated with increased incidence of heart failure: a population-based cohort study. , 2009, Atherosclerosis.

[19]  A. Waldo.  New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: results of the EuroHeart Failure Survey , 2009 .

[20]  J. Parrillo,et al.  Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. , 2008, Journal of critical care.

[21]  Philippe Pibarot,et al.  Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. , 2008, Journal of the American College of Cardiology.

[22]  D. Ross,et al.  Atrial Fibrillation in a Tertiary Care Multidisciplinary Intensive Care Unit—Incidence and Risk Factors , 2007, Anaesthesia and intensive care.

[23]  Amin Daoulah,et al.  Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. , 2007, The American journal of cardiology.

[24]  J. Le Heuzey,et al.  Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis. , 2007, European heart journal.

[25]  P. Ducimetiere,et al.  Zinc, Copper, and Magnesium and Risks for All-Cause, Cancer, and Cardiovascular Mortality , 2006, Epidemiology.

[26]  E. Pilger,et al.  The influence of elevated Mg2+ concentrations on cardiac electrophysiologic parameters , 1989, Cardiovascular Drugs and Therapy.

[27]  J. Mathew,et al.  A multicenter risk index for atrial fibrillation after cardiac surgery. , 2004, JAMA.

[28]  B. Branger,et al.  Incidence and risk factors of atrial fibrillation in a surgical intensive care unit* , 2004, Critical care medicine.

[29]  A. Lioulias,et al.  Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[30]  P. Oteiza,et al.  The antioxidant properties of zinc: interactions with iron and antioxidants. , 2001, Free radical biology & medicine.

[31]  C. Weissman,et al.  The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. , 1998, Chest.

[32]  Thomas E. Moritz,et al.  Atrial fibrillation after cardiac surgery: a major morbid event? , 1997, Annals of surgery.

[33]  P. Mills,et al.  The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery. , 1997, Heart.

[34]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[35]  J. E. Carceller.  American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis , 1992, Critical care medicine.

[36]  L. Lindgren,et al.  Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer. , 1992, The Annals of thoracic surgery.

[37]  H Artucio,et al.  Cardiac arrhythmias in critically ill patients: Epidemiologic study , 1990, Critical care medicine.

[38]  F. Morady,et al.  Effects of magnesium sulfate on cardiac conduction and refractoriness in humans. , 1986, Journal of the American College of Cardiology.

[39]  C. Decarli,et al.  Serum magnesium levels in symptomatic atrial fibrillation and their relation to rhythm control by intravenous digoxin. , 1986, The American journal of cardiology.

[40]  E. Draper,et al.  APACHE II: A severity of disease classification system , 1985, Critical care medicine.

[41]  H. Jongsma,et al.  Differences between rabbit sinoatrial pacemakers in their response to Mg, Ca and temperature. , 1983, Cardiovascular research.

[42]  A. Hollmen,et al.  The levels of zinc, copper, calcium and magnesium in serum and urine after heart-valve replacement. Effects of oxygenator type and postoperative parenteral nutrition. , 1981, Infusionstherapie und klinische Ernahrung.

[43]  K. Butler,et al.  The effect of magnesium, ATP, P i , and sodium on the inhibition of the (Na + + K + )-activated enzyme system by g-strophanthin. , 1971, Biochimica et biophysica acta.

[44]  R. Seller,et al.  Digitalis toxicity and hypomagnesemia. , 1968, American heart journal.