The Clinical Course of Patients with Atrial Fibrillation and Flutter Admitted to Medical Intensive Care Units

Abstract

To better understand the clinical course of patients with atrial fibrillation and flutter who are admitted to medi cal intensive care units (ICUs), we retrospectively re viewed the course of patients with either of these rhythms present on admission. Patients with atrial fibril lation and flutter accounted for 10% of the admissions to a combined intensive and coronary care unit over a 5- year period. These patients had an ICU mortality rate of 9.4%; the ICU deaths occurred exclusively in a subgroup of patients (60%) whose arrhythmia was associated with other serious illnesses. The subgroup of patients presenting with atrial fibrillation and flutter only had a benign course; this subgroup included patients in whom alcohol intake contributed to the rhythm disturbance. Complications occurred in 40% of patients and were predicted with multivariate analysis by (1) the presence of alveolar edema on the initial chest roentgenogram; (2) female sex; (3) diastolic blood pressure less than or equal to 95; (4) chest pain lasting more than 2 hours; and (5) ischemia on the presenting electrocardiogram. Prospective application of these criteria may be helpful in deciding which patients could be initially triaged to non-ICU areas, thereby resulting in more efficient ICU use.