Objectives: There is substantial practice variation in the management strategies for atrial fibrillation (AF) with rapid ventricular rate (RVR) and hemodynamic instability in critically ill patients. This study aimed to evaluate the use and effectiveness of direct current cardioversion (DCCV) for unstable AF RVR in the intensive care unit (ICU).
Design: Multicenter retrospective cohort study.
Setting: Non-cardiac/cardiovascular surgery ICUs of the Mayo Clinic Hospitals in Minnesota, Wisconsin, Florida, and Arizona.
Patients: Adult patients who developed paroxysmal AF RVR with hemodynamic instability (heart rate ≥ 130 beats per minute and a documented SBP ≤ 90 mmHg or the need for vasopressors) during ICU stay.
Interventions: Emergency DCCV.
Measurements And Main Results: Primary outcomes were in-hospital mortality, hospital-, ICU-, and organ support-free days. Secondary outcomes were return to sinus rhythm rate before and after discharge. Among 691 patients eligible for inclusion, 47 (6.8%) received emergent DCCV in the ICU. The frequency of DCCV was higher for patients located in surgical ICUs (14.5% vs 6.1%, = .04). Patients were 1:2 propensity-score matched. The comparative analyses were conducted on 141 patients. Those who underwent DCCV were more likely to restore sinus rhythm (odds ratio [95% confidence interval], 5.2 [1.30 20.8]). However, DCCV was not associated with increased odds of having sinus rhythm at discharge, lower mortality, or higher number of ICU-, or hospital-free days. The number of organ support-free days was significantly lower in the DCCV group (estimate ± standard error, -5.0 ± 2.0, = .012).
Conclusions: Emergency DCCV is rarely used to treat unstable AF in non-cardiac ICUs. Despite increased likelihood of immediate sinus rhythm restoration, DCCV was not associated with improvement in patient-centered outcomes. Prospective studies are warranted to evaluate harms and benefits of DCCV in non-cardiac critically ill patients with unstable AF where the driver of hemodynamic instability is often an underlying condition rather than arrhythmia per se.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1177/08850666251315332 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Estimation of inlet flow rate in simulations of left atrial flows: A proposed optimized and reference-based algorithm with application to sinus rhythm and atrial fibrillation.
J Biomech
March 2025
Department of Computational Physiology, Simula Research Laboratory, Kristian Augusts gate 23, 0164 Oslo, Norway. Electronic address:
Medical image-based computational fluid dynamics (CFD) is a valuable tool for studying cardiovascular hemodynamics and its role in vascular pathologies. However, patient-specific flow rate measurements are rare. As a remedy, individual flow rates are typically estimated using anatomical features.
View Article and Find Full Text PDFIdentifying Extra Pulmonary Vein Targets for Persistent Atrial Fibrillation Ablation: Bridging Advanced and Conventional Mapping Techniques.
Europace
March 2025
Cardiology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
Background And Aims: Advanced technologies such as charge density mapping (CDM) show promise in guiding adjuvant ablation in patients with persistent atrial fibrillation (AF); however, their limited availability restricts widespread adoption. We sought to determine whether regions of the left atrium containing CDM-identified pivoting and rotational propagation patterns during AF could also be reliably identified using more conventional contact mapping techniques.
Methods: Twenty-two patients undergoing de novo ablation of persistent AF underwent both CDM and electroanatomic voltage mapping during AF and sinus rhythm with multiple pacing protocols.
High-Power Short-Duration Temperature-Controlled Radiofrequency Ablation for the Treatment of Outflow Tract Ventricular Arrhythmias.
J Cardiovasc Electrophysiol
March 2025
2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
Introduction: The tissue temperature-controlled DiamondTemp ablation (DTA) catheter has been mainly used for atrial fibrillation ablation. We report our initial experience in using this catheter for the treatment of outflow premature ventricular contractions (PVCs) or repetitive non-sustained monomorphic ventricular tachycardias (VTs).
Methods: Twenty patients were studied: 10 with right ventricular outflow tract PVCs/VTs, eight with PVCs/VTs from the aortic sinus cusps, and two with left ventricular outflow tract PVCs.
Background: In the context of cardiovascular disease (CVD), iron metabolism assessment plays a pivotal role in the diagnosis of anemia and chronic inflammation. However, data regarding the prevalence of anemia, iron deficiency, and iron overload among outpatients in real-world clinical settings remain limited. Moreover, the influence of specific diseases on iron kinetics within the CVD spectrum has not been fully elucidated.
View Article and Find Full Text PDFAtrial fibrillation in non-ST-elevation myocardial infarction patients - worse clinical presentation and adverse long term prognosis.
Pol Merkur Lekarski
March 2025
DEPARTMENT OF CORONARY ARTERY DISEASE AND CARDIAC REHABILITATION, NATIONAL INSTITUTE OF CARDIOLOGY, WARSAW, POLAND.
Objective: . Aim: The aim of this ambispective, two-center, observational study was to evaluate the clinical characteristics and 3-years prognosis of patients with non-STelevation myocardial infarction (NSTEMI) and AF.
Patients And Methods: Materials and methods: Patients hospitalized with a diagnosis of NSTEMI were included.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!