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Abstract

Introduction: Atrial fibrillation (AF) is the most common cardiac dysrhythmia in the general population. However, its prevalence, risk factors, course, and complications are not well described in trauma patients. Hypothesis: AF is a common complication of traumatic injury that significantly affects the consequent course of critical illness. Methods: This was a retrospectivecohort study at an academic, level 1 trauma center. Trauma patients >18 years of age admitted to the intensive care unit (ICU) were sequentiallyscreened for AF from the trauma registry (02/08 – 11/10). A matched cohort was created to identify modifiable risk factors by selecting patients that were consecutively admitted before and after the patients that experienced AF. Data collection included detailed demographic, clinical and drug utilization data. Results: 191 patients experienced AF during the study period, resulting in a prevalence of 7.4% (n = 2,591). There was no difference in injury severity score (ISS) between those with and without AF, but AF patients had a significant increase in mortality (15.5% vs. 6.7%, p<0.001). Age, blunt trauma, history of AF, history of heart disease, increased ISS and SOFA scores were identifiedas risk factors associated with developing AF. Patients with a history ofAF (n = 75) differed from new-onset AF (n = 107) in their mean age (78.9 ± 8.4vs. 69.2 ± 17.9 yrs); mean time to AF onset (1.1 ± 2.3 vs. 5.2 ± 10.2 days); median duration of AF, 29.8 (1 - 745.2) vs. 5.9 (0 - 757) hrs; and rate of AF resolution, 28% vs. 82.1%. Despite a higher ISS, SOFA score, ICU and hospital LOS, and time on the ventilator, the new-onset AF group experienced a similar rate of mortality compared to the history of AF group (14.7% vs. 16.5%). Thromboembolic events were more common in the new-onset AF group (NS); patients who experienced AF were 2.5 times more likely to be discharged onanticoagulants. New-onset AF patients experienced higher heart rate at onset,took longer to achieve hemodynamic stability, and were more likely to bedischarged on a new rate control medication. Conclusions: AF appears to be a common complication of traumatic injury with important implication for management in ICU and upon discharge from the ICU.