• Travis J Moss, James Forrest Calland, Kyle B Enfield, Diana C Gomez-Manjarres, Caroline Ruminski, John P DiMarco, Douglas E Lake, and J Randall Moorman.
• 1Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA. 2Department of Surgery, University of Virginia Health System, Charlottesville, VA. 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA. 4University of Virginia School of Medicine, Charlottesville, VA.
• Crit. Care Med. 2017 May 1; 45 (5): 790-797.

ObjectiveTo determine the association of new-onset atrial fibrillation with outcomes, including ICU length of stay and survival.DesignRetrospective cohort of ICU admissions. We found atrial fibrillation using automated detection (≥ 90 s in 30 min) and classed as new-onset if there was no prior diagnosis of atrial fibrillation. We identified determinants of new-onset atrial fibrillation and, using propensity matching, characterized its impact on outcomes.SettingTertiary care academic center.PatientsA total of 8,356 consecutive adult admissions to either the medical or surgical/trauma/burn ICU with available continuous electrocardiogram data.InterventionsNone.Measurements And Main ResultsFrom 74 patient-years of every 15-minute observations, we detected atrial fibrillation in 1,610 admissions (19%), with median burden less than 2%. Most atrial fibrillation was paroxysmal; less than 2% of admissions were always in atrial fibrillation. New-onset atrial fibrillation was subclinical or went undocumented in 626, or 8% of all ICU admissions. Advanced age, acute respiratory failure, and sepsis were the strongest predictors of new-onset atrial fibrillation. In propensity-adjusted regression analyses, clinical new-onset atrial fibrillation was associated with increased hospital mortality (odds ratio, 1.63; 95% CI, 1.01-2.63) and longer length of stay (2.25 d; CI, 0.58-3.92). New-onset atrial fibrillation was not associated with survival after hospital discharge (hazard ratio, 0.99; 95% CI, 0.76-1.28 and hazard ratio, 1.11; 95% CI, 0.67-1.83, respectively, for subclinical and clinical new-onset atrial fibrillation).ConclusionsAutomated analysis of continuous electrocardiogram heart rate dynamics detects new-onset atrial fibrillation in many ICU patients. Though often transient and frequently unrecognized, new-onset atrial fibrillation is associated with poor hospital outcomes.

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