Incidence and prognosis of sustained arrhythmias in critically III patients

Abstract

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.