Clinical and echocardiographic predictors of new-onset atrial fibrillation in patients admitted with blunt trauma

Cardiac Arrhythmias in Trauma Patients Undergoing Pericardiotomy: A Retrospective Analysis

INTRODUCTION

Pericardiotomy is performed in the setting of trauma to diagnose and treat cardiac injury. The frequency of cardiac arrhythmia after pericardiotomy for trauma is poorly described in the literature. We sought to identify the frequency of and risk factors for the development of postpericardiotomy arrhythmia in trauma patients.

MATERIALS AND METHODS

We performed a retrospective single-center cohort study of patients >16 y of age, querying our institutional trauma database (Jan 2011-Dec 2020) for International Classification of Diseases-9 and -10 codes involving pericardiotomy (i.e., pericardial window, sternotomy). Operative details and postoperative course were collected for patients surviving >24 h. Sinus bradycardia and tachycardia were not included as arrhythmias.

RESULTS

We identified 252 trauma patients who underwent pericardiotomy. One hundred fifty-four patients survived >24 h. Of these, 12.3% experienced arrhythmia. Patients developing arrhythmia were older, had higher injury severity score, were more likely to have a blunt mechanism of injury, and had higher in-hospital mortality. On multiple logistic regressions, increasing age, blunt mechanism, and concomitant laparotomy were associated with arrhythmia development, while operative characteristics were not.

CONCLUSIONS

At our institution, trauma patients undergoing pericardiotomy have a risk of arrhythmia of 12.3%, which is associated with multiple nonmodifiable risk factors. Further study is warranted to identify potential mechanisms to reduce arrhythmias in this population.

Critical Care of the Burn Patient

Care of the critically ill burned patient must integrate a multidisciplinary care team composed of burn care specialists. As resuscitative mortality decreases more patients are surviving to experience multisystem organ failure relating to complications of their injuries. Clinicians must be aware of physiologic changes following burn injury and the implicated impacts on management strategy. Promoting wound closure and rehabilitation should be the backdrop for which management decisions are made.

Preoperative Electrocardiogram and Perioperative Methods for Predicting New-Onset Atrial Fibrillation During Lung Surgery

OBJECTIVE

To investigate if preoperative electrocardiogram scores and perioperative surgical methods could predict new-onset atrial fibrillation during lung surgery.

DESIGN

Retrospective observational case-control study.

SETTING

The First Affiliated Hospital of Nanjing Medical University, China.

PARTICIPANTS

Eighty adult patients (40 with new-onset atrial fibrillation, 40 without) who underwent lung surgery.

INTERVENTIONS

The authors compared and analyzed the relationship among preoperative electrocardiogram scores, clinical variables, and surgical variables with new-onset atrial fibrillation during lung surgery.

MEASUREMENTS AND MAIN RESULTS

Clinical data and demographics involving 80 adult patients (40 with new-onset atrial fibrillation, 40 without) who underwent lung surgery were retrieved from the Medical Records of the First Affiliated Hospital of Nanjing Medical University. Patients with prior atrial fibrillation were excluded. Preoperative electrocardiograms were collected from medical records and checked by two independent blinded researchers. Preoperative clinical variables (age, sex, body mass index, American Society of Anesthesiologists Class) were selected for a multivariate preoperative clinical model (model C). Perioperative surgical methods (thoracoscopy or open-chest surgery, lymph node dissection, left or right pneumonectomy, extent of pulmonary resection) were selected for a multivariate surgical methods model (model S). Five electrocardiogram variables (PR interval, P-wave duration, the longest interval measured between the onset of Q-wave and the J-point (QRS) duration, left atrial enlargement, and left ventricular hypertrophy) were included in a multivariate electrocardiogram model (model E). A combined clinical and electrocardiogram model (Model CE) and a combined univariate significant variables model (Model CSE) were formed. Left atrial enlargement, QRS duration, American Society of Anesthesiologists Class, and open-chest surgery were risk factors of new-onset atrial fibrillation. The result showed that the predictive ability of Model E was significantly higher than Models C and S. Model CSE showed the highest prediction of all models. Fifty percent of patients with one risk element will develop new-onset atrial fibrillation, and 100% of patients with two or more risk elements of Model CSE will develop new-onset atrial fibrillation.

CONCLUSIONS

Preoperative electrocardiogram markers can be used together with surgical methods as strong predictors to identify those patients at a high risk for new-onset atrial fibrillation during lung surgery.

Left Atrium Dilatation and Left Ventricular Hypertrophy Predispose to Atrial Fibrillation in Patients With Community-Acquired Pneumonia

Atrial fibrillation (AF) is one of the most common cardiovascular complications in patients hospitalized with community-acquired pneumonia (CAP). However, predisposing clinical factors associated with AF in CAP patients have not been fully elucidated. We enrolled 545 patients consecutively hospitalized for CAP. Data on demographic characteristics and co-morbidities were collected and all patients underwent ECG, echocardiography, and laboratory measurements. During the in-hospital stay, 9.5% of patients experienced a new episode of AF within 24 to 72 hours from admission. CAP patients who experienced AF had a higher indexed left atrial area (LAAi) and a higher proportion of concentric left ventricular hypertrophy than those not presenting AF. Univariate logistic regression analysis showed that hypertension, history of coronary heart disease, high Pneumonia Severity Index classes, history of paroxysmal AF, systolic heart failure, concentric left ventricular hypertrophy, and an enlarged LAAi were associated with a new episode of AF. A multivariable logistic analysis showed that history of paroxysmal AF (odds ratio [OR] 11.7; 95% confidence interval [CI] 5.8 to 23.7; p <0.001), enlarged LAAi (OR 5.4; 95% CI 2.5 to 11.9; p <0.001), and concentric left ventricular hypertrophy (OR 2.2; 95 CI 1.1 to 4.6; p = 0.034) remained independently associated with AF occurrence. In conclusion, in this large cohort of CAP patients, history of paroxysmal AF, enlarged LAAi, and concentric left ventricular hypertrophy are independent predictors of AF occurrence during the early stages of pneumonia.