Introduction Atrial fibrillation (AF) is common in the intensive care unit (ICU) setting, and has been associated with adverse outcomes. In this context, there is increasing research interest in AF burden as a predictor of subsequent adverse events. However, the pathophysiology and drivers of AF burden in ICU are poorly understood. This study sought to evaluate the predictors of AF burden in critical illness associated new onset AF (CI-NOAF). Methods Out of 7,030 admissions a tertiary general intensive care unit between December 2015 and September 2018, 309 patients developed CI-NOAF. AF burden was defined as the percentage of monitored time in AF, as extracted from hourly interpretations of continuous ECG monitoring. Low and high AF burden groups were defined relative to the median AF burden. Clinical, laboratory and echocardiographic parameters were extracted, and multivariable modelling with binary logistic regression was performed to evaluate for independent associations with AF burden. Results The median AF burden was 7.0%. Factors associated with increased AF burden were age, dyslipidaemia, chronic kidney disease, increased creatinine, CHA2DS2-VASc score, ICU admission diagnosis category, amiodarone administration and left atrial area (LAA). Factors associated with lower AF burden were previous alcohol excess, burden of ventilation, the use of inotropes/vasopressors and beta blockers. On multivariate analysis, increased LAA, chronic kidney disease and amiodarone use were independently associated with increased AF burden, whereas beta blocker use was associated with lower AF burden. Conclusion Left atrial size and chronic cardiovascular comorbidities appear to be the primary drivers of CI-NOAF burden, whereas factors related to acute illness and critical care intervention paradoxically did not appear to be a substantial driver of arrhythmia burden. Further research is needed regarding drivers of AF and the efficacy of rhythm control intervention in this unique setting.

中文翻译：

---

危重病人新发房颤负担的预测因子。

简介 心房颤动 (AF) 在重症监护病房 (ICU) 中很常见，并且与不良后果相关。在这种背景下，人们越来越关注房颤负担作为后续不良事件的预测因素。然而，人们对 ICU 房颤负担的病理生理学和驱动因素知之甚少。本研究旨在评估危重疾病相关新发房颤 (CI-NOAF) 中房颤负担的预测因素。方法 2015 年 12 月至 2018 年 9 月期间，三级普通重症监护病房收治了 7,030 名患者，其中 309 名患者出现 CI-NOAF。AF 负担定义为 AF 监测时间的百分比，从连续心电图监测的每小时解释中提取。低和高 AF 负担组是相对于中位 AF 负担来定义的。提取临床、实验室和超声心动图参数，并使用二元逻辑回归进行多变量建模，以评估与 AF 负担的独立关联。结果 AF 负担中位数为 7.0%。与 AF 负担增加相关的因素包括年龄、血脂异常、慢性肾脏疾病、肌酐升高、CHA2DS2-VASc 评分、ICU 入院诊断类别、胺碘酮给药和左心房面积 (LAA)。与较低 AF 负担相关的因素包括既往饮酒过量、通气负担、正性肌力药/血管加压药和 β 受体阻滞剂的使用。多变量分析显示，左心耳面积增加、慢性肾病和胺碘酮的使用与房颤负担增加独立相关，而β受体阻滞剂的使用与房颤负担降低相关。结论 左心房大小和慢性心血管合并症似乎是 CI-NOAF 负担的主要驱动因素，而与急性疾病和重症监护干预相关的因素似乎并不是心律失常负担的重要驱动因素。需要进一步研究房颤的驱动因素以及在这种独特环境下节律控制干预的有效性。