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Clinical Summary

Afib cardioversion: in surgical ICU, higher potassium boosts success

Takeaway

  • For noncardiac postsurgical patients with Afib, electrical cardioversion (ECV) to sinus rhythm (SR) is more successful among those whose serum potassium was ≥3.8 mol/L.
  • Results underscore those of previous studies. 

Why this matters

  • Few data address Afib incidence or ECV success rates in noncardiac surgical ICU patients.

Key results

  • ECV succeeded in 48% of patients (41).
  • Of those, 73% (30) experienced recurrent Afib.
  • Among the 44 patients whose ECV was unsuccessful, 37 returned to SR during ICU stay.
  • ECV success was predicted by serum K≥3.8 mol/L on multivariate analysis adjusted for arterial pH: OR, 3.13 (95% CI, 1.07-9.11; P=.04).
  • ICU success was predicted by 2 factors on multivariate analysis adjusted for APACHE score:
    • Higher arterial pH (per 0.1 increase): OR, 3.02 (95% CI, 1.61-5.67; P=.0006); and
    • SR maintained until ICU discharge: OR, 9.35 (95% CI, 1.02-85.78; P=.048).

Study design

  • Retrospective single-center observational study of ICU patients with new-onset Afib undergoing ECV (n=85).
  • Authors assessed predictors of cardioversion success, mortality.
  • Funding: None.

Limitations

  • Small single-center study, limited to patients with new-onset Afib.
  • Serum magnesium data were mostly missing.
  • ECV energies varied.

References


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