New-onset, postoperative tachyarrhythmias in critically ill surgical patients

JBUR 5309 No. of Pages 7

burns xxx (2017) xxx –xxx

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevier.com/locate/burns

Review

New-onset, postoperative tachyarrhythmias in critically ill surgical patients Eileen Bernal * , Steven Wolf, Michael Cripps Division of Burn/Trauma/Critical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA

article info

abstract

Article history:

Tachyarrhythmias in critically ill surgical patients can have varying effects, from minimal

Accepted 16 June 2017

consequence to lifetime sequelae. Atrial fibrillation can be common in the post-operative

Available online xxx

period, often a result of fluctuations in volume status and electrolyte derangements. While there is extensive literature regarding the critically ill medical or cardiac patient, there is less

Keywords: Burn patient Atrial fibrillation Arrhythmia Tachyarrhythmia Trauma Surgical critical care Critical care

focusing on the critically ill surgical or trauma patient. More specifically, there is minimal regarding tachyarrhythmias in burn patients. The latter population tends to have frequent and wide variations in volume status given initial resuscitation and after major excisions, concomitant with acute blood loss anemia, which can contribute to cardiac disturbances. A literature review was conducted to investigate the incidence and consequences of tachyarrhythmias in critically ill surgical and trauma patients, with a focus on the burn population. While some similarities and conclusions can be drawn between these surgical populations, further inquiry into the unique burn patient is necessary. © 2017 Elsevier Ltd and ISBI. All rights reserved.

Contents 1. 2.

3.

4.

5.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tachyarrhythmias in critically ill surgical patients . 2.1. Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2. Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3. Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tachyarrhythmias in trauma patients . . . . . . . . . . . . 3.1. Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2. Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3. Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tachyarrhythmias in burn patients . . . . . . . . . . . . . . 4.1. Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2. Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3. Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conflicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . .

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

.... .... .... .... .... .... .... .... .... .... .... .... .... .... ....

. . . . . . . . . . . . . . .

* Corresponding author at: 11760 Bird Road, Suite 722, Miami, FL 33175, USA. E-mail address: [email protected] (E. Bernal). http://dx.doi.org/10.1016/j.burns.2017.06.012 0305-4179/© 2017 Elsevier Ltd and ISBI. All rights reserved.

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00

JBUR 5309 No. of Pages 7

2

burns xxx (2017) xxx –xxx

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

1.

Introduction

Cardiac rhythm disturbances, specifically tachyarrhythmias, are frequently encountered in critically ill patients. While the incidence or prevalence of cardiac rhythm abnormalities in patients after cardiac surgery [1–4] or with cardiac or pulmonary disease has been extensively described [5–23], there is a paucity of data regarding critically ill surgical patients. There is less information known in the trauma population and data in burned patients is lacking [24–29]. New onset of tachyarrhythmias is especially problematic in the surgical intensive care unit (ICU). The Framingham Heart Study found atrial fibrillation to be associated with a 1.5-fold increase in risk for death from all causes in men and a 1.9-fold increase in women [30]. While most episodes of postoperative atrial fibrillation tend to be self-limiting, they are often recurrent, and if persistent, associated with an increased risk of stroke or transient ischemic attack after 48h [31,32], other thromboembolic events and heart failure [33]. Whether an indicator of injury severity or an independent risk factor for death [30], the effect of tachyarrhythmias in critically ill patients can contribute to increased morbidity and mortality in some patients, and minimal residual consequence in others, with the impact dependent upon the patient’s cardiac physiology and function [31,34]. Review of the available literature demonstrates the need for further research into these specific populations, especially with regard to expected consequences of newonset tachyarrhythmias. The following keywords were utilized in the systematic review of the literature: burn patient, atrial fibrillation, arrhythmia, tachyarrhythmia, trauma, surgical critical care, critical care. While literature regarding medical critical care patients was also reviewed, the focus was primarily on critically ill surgical and trauma patients as a comparison to burn patients given inherent similarities.

2. Tachyarrhythmias in critically ill surgical patients 2.1.

Incidence

The incidence of supraventricular tachycardias, specifically atrial fibrillation, may occur in as many as 30–40% of postoperative cardiac surgical patients, as well as in up to 4% of postoperative patients undergoing non-cardiac surgery [31,35,36]. Regarding the incidence of arrhythmias in a mixed ICU, Artucio and Pereira’s epidemiologic study is the first to comment on the incidence of cardiac arrhythmias in critically ill patients [24]. This study found an overall prevalence of cardiac arrhythmias of 78% in their 2,820 consecutive patients, with 44% in multiply injured trauma patients. Atrial tachyarrhythmias had the highest prevalence overall (28%) with atrial fibrillation the most common atrial arrhythmia (52%) (Fig. 1). In a similar review of postoperative surgical patients admitted to a surgical ICU, Knotzer et al. found an incidence of 14.9% of tachyarrhythmias out of 596 patients. Atrial fibrillation and atrial flutter were the most common, found in 54 of the 89 patients that developed tachyarrhythmias. While they do not comment on the specifics of the particular operative procedures, they mention that approximately twothirds of their patients were admitted to the surgical ICU after major cardiothoracic and abdominal surgery [37]. In a retrospective review of 13,696 patients, Christians et al. found 51 patients with new-onset atrial fibrillation within 30days of a non-cardiac, non-thoracic surgical procedure without chest trauma or concomitant pulmonary emboli, noting an incidence of 0.37% [38].

2.2.

Causes

Atrial fibrillation is the most common tachyarrhythmia and the incidence increases with advancing age [39], doubling with each decade of adult life [40] and can be seen in 0.5–1.0% of the

Fig. 1 – Atrial fibrillation with rapid ventricular response. Lack of p waves is characteristic of atrial fibrillation.

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

JBUR 5309 No. of Pages 7

burns xxx (2017) xxx –xxx

general population [41]. Causes are varied and can include increased left atrial size, increased sympathetic nervous system activity, increased vagal tone, increased intravascular volume or postoperative hypovolemia, hypothermia, and electrolyte derangements [34,42,43]. Additional risk factors for the development of tachyarrhythmias include male sex, a history of previous cardiac arrhythmias, acute myocardial ischemia, and preexisting cardiorespiratory disease [37,44–47] and can be more common in patients with any preexisting structural cardiac disease [31]. In non-cardiac surgical patients, this electrocardiographic abnormality is most commonly observed on postoperative (POD) day one and has been associated with fluid balance disturbances, electrolyte abnormalities, and decreased oxygen saturations [38]. When symptomatic, patients complain of chest pain or tightness, lightheadedness, or palpitations and many experience some hemodynamic changes in blood pressure, heart rate, or both. In contrast to other studies, Knotzer et al. did not find any significant differences regarding preexisting comorbidity, preexisting cardiovascular disease, or antiarrhythmic medication between their study and control groups [37]. They did, however, conclude that the development of systemic inflammatory response syndrome (SIRS) and sepsis was the most important risk factor of tachyarrhythmia, increasing the relative risk of incidence of tachyarrhythmia by 36 times, a conclusion similarly drawn by Goodman et al. [48]. High central venous pressures and catheters and pulmonary artery catheters have also been studied in the incidence of supraventricular tachycardias, with conflicting results. While Knotzer found high central venous pressure to be a significant predictor for the development of new-onset tachyarrhythmias, Seguin et al. found central venous catheters more frequently observed in patients with atrial fibrillation, but concluded that only the presence of a pulmonary artery catheter was actually an independent risk factor [41]; Goodman et al. did not find either to be a predictor [48]. Additional independent risk factors identified by Seguin et al. included age, blunt thoracic trauma, shock, and previous treatment by calcium channel blockers.

2.3.

Outcomes

ICU patients who develop atrial fibrillation are more critically ill, receive more fluids and catecholamines, experience more sepsis and acute renal failure, and have a prolonged hospitalization associated with a higher use of resources [49]. In their study, Knotzer et al. found that nearly 24% of their patients (21/89) developed tachyarrhythmias within 24h of admission and suffered a 36.4% mortality rate as compared to 11.4% in those patients who did not develop any tachyarrhythmia [37]. While they do not comment on the elective or urgent basis of the surgical procedures, Christians et al. mention that patients were of acceptable operative risk, yet 16% remained in atrial fibrillation at the time of discharge, 71% were discharged on new cardiac medications, and 12% died [38]. Whether an indicator of illness severity or a prognostic factor, tachyarrhythmias of new onset in the critically ill surgical patient is associated with increased morbidity and mortality. Goodman et al. uniquely commented on 4-year survival data in surgical ICU patients with new-onset

3

supraventricular arrhythmias, noting that almost all deaths in this group occurred during hospitalization and that mortality over the subsequent 3 years was minimal [48].

3.

Tachyarrhythmias in trauma patients

3.1.

Incidence

Myocardial contusion is often cited as a contributing factor to the incidence of tachyarrhythmia in the trauma patient. However, Seguin et al. prospectively studied the incidence of atrial fibrillation in trauma patients, of which only 2 (12.5%) had confirmed myocardial contusion [49]. They identified five independent risk factors for the development of atrial fibrillation: catecholamine use, a Simplified Acute Physiology Score II (SAPS II) of 30 or higher at admission, three or more regions traumatized, age 40 years or older, and the presence of SIRS. Of their 293 patients studied, 16 (5.5%) developed newonset atrial fibrillation of which 3 (19%) were treated with electrical cardioversion, 4 (25%) with amiodarone, 1 with digoxin (6%), 4 (25%) with other treatments, and 4 (25%) resolved without intervention. As mentioned, Artucio and Pereira found an incidence of 44% in their multiply injured trauma patients [24].

3.2.

Causes

Most studies of tachyarrhythmias in trauma patients have focused on blunt thoracic injury, specifically myocardial contusions [50,51]. Other causes of new-onset tachyarrhythmias in the absence of myocardial contusion have not been uniquely identified in the trauma population. Rather, hemodynamic instability, fluid imbalance, and electrolyte abnormalities have similarly contributed as in the critically ill, nontrauma, surgical patient.

3.3.

Outcomes

In the Seguin et al.’s study, there was a significant and predictably higher administration of crystalloid, blood transfusions, and catecholamines in those patients who suffered atrial fibrillation. Additionally, the incidence of frequent SIRS, sepsis, shock, and acute renal failure was also significantly higher. While those with atrial fibrillation had a longer ICU length of stay and both ICU and hospital mortality rates twice as high as those without atrial fibrillation, total hospital length of stay did not differ amongst the two groups [49].

4.

Tachyarrhythmias in burn patients

4.1.

Incidence

Acute burn is characterized by a hypermetabolic response that includes a surge of sympathetic activity with an increased release of catecholamines, predisposing affected patients to the development of electrocardiographic abnormalities and cardiac arrhythmias [25–27,52–54]. This hypermetabolic state, directly proportional to the size of the burn, may reach near

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

JBUR 5309 No. of Pages 7

4

burns xxx (2017) xxx –xxx

250% above the basal metabolic rate in patients with a more than 50% total body surface area (TBSA) burn [25]. Additionally, during the early period post burn, it has been suggested that hypovolemia associated with persisting capillary leakage is the cause of impaired myocardial performance [55,56]. However, other studies suggest that the secretion of proinflammatory mediators by the cardiomyocyte leads to the early myocardial dysfunction with TNF-alpha playing a significant role [57,58]. While the clinical groups in the Artucio and Pereira’s study included septic and multiply injured trauma patients, the unique burn patient population was absent from their review [24]. Often, accurate diagnosis of myocardial illness is difficult to ascertain in burn patients due to bandages obscuring the placement of leads for accurate electrocardiographic recordings, and narcotic and sedative use, unconsciousness, thoracic wounds, and mechanical ventilation impeding sufficient communication of chest pain [59]. In a study by Goff et al., the incidence of cardiac complications in burn patients was prospectively reviewed, with a comparison between patients with a prior cardiac history and those without. Of their 257 patients, 115 had a prior cardiac history, and 62 of these patients (54%) had no inhospital cardiac events, but the remaining 53 (46%) did suffer at least one event during their hospitalization. The other 142 patients did not have any prior cardiac history, but as a group sustained 223 in-hospital cardiac events, with arrhythmias the most common at 33% [25]. Meyers et al. also studied the incidence of cardiac events in burned patients, as compared to a matched cohort of trauma patients. Although a small and retrospective review, they found a higher frequency of cardiac events in both populations, with benign cardiac arrhythmias the most common at 34% and 28% in trauma and burn patients, respectively, P=0.224 [27]. In a study by Iyah et al., 53% of their 34 patients were found to have a prolonged QTc (>450ms); the authors excluded electrical burns and noted that electrocardiographic abnormalities did not correlate with extent or severity of burn. The incidence of electrocardiographic abnormalities dropped to 38% when excluding prolonged QTc, and the incidence of atrial fibrillation was 5.8% [26] and consisted of 2 patients: a 34-yearold male with a 6.5% TBSA second-degree burn and an 82-yearold female with a 12% TBSA third-degree burn. These findings are similar to those in the study by Meyers et al. that matched burn patients to trauma patients and found an incidence of cardiac arrhythmias in 34% and 28%, respectively [27]. In the Meyers et al. study, while the study population had a higher frequency of (benign) cardiac arrhythmias, the authors concluded that burn patients are not at significantly higher risk than other multiply injured patients for severe cardiac complications. In a larger prospective study by Goff et al., the incidence of new arrhythmias in burn patients with either a prior cardiac history or an in-hospital cardiac event was reviewed. Over the 5-year study period, 2,477 patients were admitted to their burn center, of which 257 (10.4%) met the inclusion criteria and had a new arrhythmia not associated with hypoxia or electrolyte abnormality. The authors found 115 patients to have a cardiac history before burn and 142 patients with no prior cardiac history but with an in-hospital cardiac event [25].

4.2.

Causes

Increased cardiac demand in critically ill patients is marked by a hypermetabolic state, mediated by increased sympathetic activity and a catecholamine surge. This increase in adrenergic stimulation can trigger myocardial infarction and cardiac arrhythmias [27,40,60–62]. This response is heightened in the critically ill surgical or trauma patient, and exaggerated in the burn patient. Bak et al. found that the proportion of combined left ventricular regional dysfunction and troponin leak is higher in burn patients than their mixed ICU counterparts [59]. This population may be uniquely predisposed to electrocardiographic abnormalities given changes in their fluid volume and electrolyte status as a response to resuscitation, excision, and grafting; hypercoagulability; and increased platelet aggregability [25,27,52– 54,63,64]. With early changes in both systolic and diastolic variables, it has been suggested that the burn itself may have a primary myocardial effect [59].

4.3.

Outcomes

Several studies have shown that while electrocardiographic abnormalities are not infrequent in burn patients, patient outcomes are often good. As these studies are often small and retrospective in nature, guideline criteria for intervention are currently lacking. Despite a similar incidence of cardiac events in trauma and burn patients, Meyers et al. concluded that burn patients are not at a substantially greater risk of important cardiac complications than are other similarly injured patients [27]. In the Goff study, cardiac complications included 28 noted arrhythmias in the group with a prior cardiac history and 74 in the group without a prior history, for a total of 102 in-hospital cardiac events. While hypotension and congestive heart failure were among the other common in-hospital cardiac complications, arrhythmias were the most frequent, primarily premature ventricular depolarization. With an incidence of 6% cardiac death in the study group, cardiac disease was seen to significantly alter the management and outcome of the acutely burned patient [25]. For burn patients, other chronic cardiac complications include cardiomyopathy and congestive heart failure, which can lead to significant morbidity and mortality, and can occur as late as 6 months after burn [64,65]. A case report by Miotto et al. comments on a 56-year-old male patient without a previous cardiac history who sustained a 47% TBSA with deep secondand third-degree burns. Although he had an abnormal initial electrocardiogram (ECG), he had remaining normal ECGs thereafter until POD 30 when lateral ischemia developed and cardiology consultation was sought. Thereafter, the patient was asymptomatic with normal ECGs again until POD 39 when he sustained ventricular fibrillation and was cardioverted. He ultimately underwent cardiac catheterization on POD 55, during which he was found to have 95% stenosis of both left anterior descending and diagonal branches of the left main coronary artery, an ejection fraction of 40%, and severe anteroapical hypokinesis for which he underwent percutaneous transcoronary angioplasty on POD 59. This patient was ultimately discharged to home on post-burn day 111 and started on

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

JBUR 5309 No. of Pages 7

burns xxx (2017) xxx –xxx

outpatient antiplatelet therapy [66]. This and one other case report by Gregg et al. demonstrate either the paucity of information regarding cardiac intervention in burn patients or reflect the actual infrequency of such need [67].

[3]

[4]

5.

Conclusions [5]

Despite the prevalence of new-onset atrial fibrillation in postoperative patients, it remains unclear whether mortality is directly attributable to the atrial fibrillation, or if this tachyarrhythmia is merely a marker of greater disease severity. While the cardiac surgical population is most studied regarding new-onset, postoperative tachyarrhythmias, information about the incidence and implications of tachyarrhythmias in burn patients is lacking in the literature. Metabolic and fluid derangements are known to be associated with cardiovascular consequences, likely making burn patients vulnerable to the latter. This seemingly susceptible population has not been fully evaluated for the incidence of new-onset tachyarrhythmias, specifically atrial fibrillation, or the consequences of such. With the incidence of cardiac complications in burn patients as described by the studies summarized above, parameters or guidelines as to which patients would benefit from cardiac intervention are currently lacking in the literature. Conclusions from previous studies may lend themselves to treatment strategies and management in the burn patient, but this unique population should be singled out for further review.

[6]

[7]

[8]

[9] [10]

[11] [12]

[13]

[14]

Conflicts of interest The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patient-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Acknowledgements The authors would like to thank Dave Primm, Editor in the Division of Research in the Department of Surgery at the University of Texas Southwestern Medical Center, for his writing assistance.

[15]

[16]

[17]

[18]

[19]

[20] REFERENCES

[1] Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56 (3):539–49. [2] Leitch JW, Thomson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary

[21] [22]

5

artery bypass grafting. J Thorac Cardiovasc Surg 1990;100 (September (3)):338–42. Tam SK, Miller JM, Edmunds Jr. LH. Unexpected, sustained ventricular tachyarrhythmia after cardiac operations. J Thorac Cardiovasc Surg 1991;102(December (6)):883–9. Topol EJ, Lerman BB, Baughman KL, Platia EV, Griffith LS. De novo refractory ventricular tachyarrhythmias after coronary revascularization. Am J Cardiol 1986;57(1):57–9. DeSanctis RW, Block P, Hutter AM. Symposium myocardial infarction 1972 (Part 3): tachyarrhythmias in myocardial infarction. Circulation 1972;45:681. Holmes J, Kubo SH, Cody RJ, Kligfield P. Arrhythmias in ischemic and nonischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography. Am J Cardiol 1985;55(January (1)):146–51. Norris RM, Singh BN. Arrhythmias in acute myocardial infarction. In: Norris RM, editor. Myocardial infarction: its presentation, pathogenesis, and treatment. Edinburgh: Churchill Livingstone; 1982. p. 55–64. Rotman M, Wagner GS, Wallace AG. Bradyarrhythmias in acute myocardial infarction. Circulation 1972;45(March (3)):703–22. Corazza LJ, Pastor BH. Cardiac arrhythmias in chronic cor pulmonale. NEJM 1958;259(October (18)):863–5. Goldberg LM, Bristow JD, Parker BM, Ritzmann LW. Paroxysmal atrial tachycardia with atrioventricular block: its frequent association with chronic pulmonary disease. Circulation 1960;21:499. Thomas AJ, Valabhji P. Arrhythmia and tachycardia in pulmonary heart disease. Br Heart J 1969;31(July (4)):491–5. Holford FD, Mithoefer JC. Cardiac arrhythmias in hospitalized patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1973;108(October (4)):879–85. Hudson LD, Kurt TL, Petty TL, Genton E. Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 1973;63(May (5)):661–5. Kleiger RE, Senior RM. Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest 1974;65(May (5)):483–7. Artucio H, Mazza N, Correa H, Wolyvovics M, Moulia M. Arritmias cardiacas en enfermedad pulmonar obstructiva cronica. El Torax 1975;24:196. Josephson GW, Kennedy HL, MacKenzie EJ, Gibson G. Cardiac dysrhythmias during the treatment of acute asthma: a comparison of two treatment regimens by a double blind protocol. Chest 1980;78(September (3)):429–35. Valverde Conde A, Penas Maldonado L, Delgado Lacosta M, Garcia Gonzalez M, Sanz Hernan JJ. Factores determinantes de la aparicion de arritmias en pacientes con enfermedad pulmonary obstructiva cronica y fallo respiratorio aguda. Med Intensiva 1987;11(1):6–11. Berger PB, Ruocco Jr. NA, Ryan TJ, Frederick MM, Jacobs AK, Faxon DP. Incidence and prognostic implications of heart block complicating inferior myocardial infarction treated with thrombolytic therapy: results from TIMI II. J Am Coll Cardiol 1992;20(September (3)):533–40. Gulsvik A, Hansteen V, Sivertssen E. Cardiac arrhythmias in patients with serious pulmonary diseases. Scand J Respir Dis 1978;59(June (3)):154–9. Heinz G, Kratochwill C, Schmid S, Kreiner G, Siostrzonek, Pacher R, et al. Sinus node dysfunction after orthotopic heart transplantation: the Vienna experience 1987–1993. Pacing Clin Electrophysiol 1994;17(November (11 Pt. 2)):2057–63. Kurt TL, Hudson LD, Petty TL, Genton E. Arrhythmias in respiratory failure. NEJM 1973;288(March (9)):470–1. Pavri BB, O’Nunain SS, Newell JB, Ruskin JN, William G. Prevalence and prognostic significance of atrial arrhythmias after orthotopic cardiac transplantation. J Am Coll Cardiol 1995;25(June (7)):1673–80.

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

JBUR 5309 No. of Pages 7

6

burns xxx (2017) xxx –xxx

[23] Singh SN, Fletcher RD, Fisher SG, Singh BN, Lewis HD, Deedwania PC, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival trial of antiarrhythmic therapy in congestive heart failure. NEJM 1995;333(July (2)):77–82. [24] Artucio H, Pereira M. Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med 1990;18 (December (12)):1383–8. [25] Goff DR, Purdue GF, Hunt JL, Cochran RP. Cardiac disease and the patient with burns. J Burn Care Rehabil 1990; 11(July–August (4)):305–7. [26] Iyah GR, Reddy PC, El-Amin O, Caldito GC. Electrocardiographic abnormalities in patients with acute burn injuries. J La State Med Soc 2008;160(January–February (1)) 39–40 42–33. [27] Meyers DG, Hoestje SM, Korentager RA. Incidence of cardiac events in burned patients. Burns 2003;29(June (4)):367–8. [28] Purdue GF, Hunt JL. Electrocardiographic monitoring after electrical injury: necessity or luxury. J Trauma 1986;26 (February (2)):166–7. [29] Suzuki M, Aoki K, Sekine K, Aikawa N. Correlation between QT dispersion and burn severity. Burns 2002;28(August (5)):481–5. [30] Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98(September (10)):946–52. [31] Heintz KM, Hollenberg SM. Perioperative cardiac issues: postoperative arrhythmias. Surg Clin North Am 2005;85 (December (6)):1103–14. [32] Taylor GJ, Malik SA, Colliver JA, Dove JT, Moses W, Mikell FL, et al. Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting. Am J Cardiol 1987;60(October (10)):905–7. [33] Levy D, Kannel WB. Postoperative atrial fibrillation and mortality: do the risks merit changes in clinical practice? J Am Coll Cardiol 2004;43(March (5)):749–51. [34] Brathwaite D, Weissman C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest 1998; 114(August (2)):462–8. [35] Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med 2001;135(December (12)):1061–73. [36] Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998;129(August (4)):279–85. [37] Knotzer H, Mayr A, Ulmer H, Lederer W, Schobersberger N, Hasibeder W. Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study. Intensive Care Med 2000;26(July (7)):908–14. [38] Christians KK, Wu B, Quebbeman EJ, Brasel KJ. Postoperative atrial fibrillation in noncardiothoracic surgical patients. Am J Surg 2001;182(December (6)):713–5. [39] Coumel P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J 1994;15(April (Suppl. A)):9–16. [40] Falk RH. Atrial fibrillation. NEJM 2001;344(April (14)):1067–78. [41] Seguin P, Signouret T, Laviolle B, Branger B, Malledant Y. Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med 2004;32(March (3)):722–6. [42] Gottlieb SS, Baruch L, Kukin ML, Bernstein JL, Fisher ML, Packer M. Prognostic importance of the serum magnesium concentration in patients with congestive heart failure. J Am Coll Cardiol 1990;16(October (4)):827–31. [43] Simpson Jr. RJ, Foster JR, Mulrow JP, Gettes LS. The electrophysiological substrate of atrial fibrillation. Pacing Clin Electrophysiol 1983;6(September (5 Pt. 2)): 1166–70.

[44] Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 1997;226(October (4))501–11 discussion 511–513. [45] Habet KJ, Calvin JE. Arrhythmias and heart block in the critically ill. Curr Opin Crit Care 1995;1(5):402–9. [46] Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 1996; 276(July (4)):300–6. [47] Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271(March (11)):840–4. [48] Goodman S, Shirov T, Weissman C. Supraventricular arrhythmias in intensive care unit patients: short and long-term consequences. Anesth Analg 2007;104(April (4)):880–6. [49] Seguin P, Laviolle B, Maurice A, Leclercq C, Malledant Y. Atrial fibrillation in trauma patients requiring intensive care. Intensive Care Med 2006;32(March (3)):398–404. [50] Cachecho R, Grindlinger GA, Lee VW. The clinical significance of myocardial contusion. J Trauma 1992;33(July (1))68–71 discussion 71–63. [51] McLean RF, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Dirkson D. Significance of myocardial contusion following blunt chest trauma. J Trauma 1992; 33(August (2)):240–3. [52] Dolecek R. Burn stress and its endocrine consequences. A review. Acta Chir Plast 1984;26(2):107–28. [53] Kaufman TM, Horton JW. Burn-induced alterations in cardiac beta-adrenergic receptors. Am J Physiol 1992;262(May (5 Pt 2)): H1585–1591. [54] Lowe MD, Rowland E, Brown MJ, Grace AA. Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium. Heart 2001;86(July (1)):45–51. [55] Jandziol A, Hayes M. The cardiovascular response to burn injury. Curr Anaesth Crit Care 2008;19:269–74. [56] Papp A, Uusaro A, Parviainen I, Hartikainen J, Ruokonen E. Myocardial function and haemodynamics in extensive burn trauma: evaluation by clinical signs, invasive monitoring, echocardiography and cytokine concentrations. A prospective clinical study. Acta Anaesthesiol Scand 2003;47(10):1257–63. [57] Bryant D, Becker L, Richardson J, Shelton J, Franco F, Peshock R, et al. Cardiac failure in transgenic mice with myocardial expression of tumor necrosis factor-alpha. Circulation 1998;97 (April (14)):1375–81. [58] Kumar A, Thota V, Dee L, Olson J, Uretz E, Parrillo JE. Tumor necrosis factor alpha and interleukin 1beta are responsible for in vitro myocardial cell depression induced by human septic shock serum. J Exp Med 1996;183(March (1)):949–58. [59] Bak Z, Sjoberg F, Eriksson O, Steinvall I, Janerot-Sjoberg B. Cardiac dysfunction after burns. Burns 2008;34(August (5)):603–9. [60] Coumel P. Autonomic influences in atrial tachyarrhythmias. J Cardiovasc Electrophysiol 1996;7(October (10)):999–1007. [61] Verrier RL, Mittleman MA. Life-threatening cardiovascular consequences of anger in patients with coronary heart disease. Cardiol Clin 1996;14(May (2)):289–307. [62] McGovern BA, Liberthson R. Arrhythmias induced by exercise in athletes and others. S Afr Med J 1996;86(April (Suppl. 2)): C78–82. [63] Merriam Jr. TW. Myocardial function following thermal injury. Circ Res 1962;11(October):669–73. [64] Chen TJ, Shen BH, Yeh FL, Lin JT, Ma H, Huang CH, et al. Delayed dilated cardiomyopathy for major burn injuries. Burns 2003;29 (June (4)):343–8.

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012

JBUR 5309 No. of Pages 7

burns xxx (2017) xxx –xxx

[65] Mak GZ, Hardy AR, Meyer RA, Kagan RJ. Reversible cardiomyopathy after severe burn injury. J Burn Care Res 2006;27(July–August (4)):482–6. [66] Miotto PJ, Shupp JW, Jeng JC, Lee K, Jordan MH. Percutaneous transcoronary angioplasty and electrophysiological

7

stimulation during acute management of a patient with severe burns. Burns 2010;36(August (5)):e72–4. [67] Gregg SC, Fidler PE, Atweh NA. Coronary stenting during burn shock: diagnostic and treatment considerations. J Burn Care Res 2006;27(November–December (6)):905–9.

Please cite this article in press as: E. Bernal, et al., New-onset, postoperative tachyarrhythmias in critically ill surgical patients, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.06.012