Initial treatment strategies in new-onset atrial fibrillation in critically ill burn patients

Mithun R Suresh; Alexander C Mills; Garrett W Britton; Wilson B Pfeiffer; Marissa C Grant; Julie A Rizzo

Initial treatment strategies in new-onset atrial fibrillation in critically ill burn patients

Int J Burns Trauma. 2022 Dec 15;12(6):251-260. eCollection 2022.

Authors

Mithun R Suresh¹, Alexander C Mills², Garrett W Britton³, Wilson B Pfeiffer⁴, Marissa C Grant⁴, Julie A Rizzo^{5

6}

Affiliations

¹ Department of Medicine, CentraCare-St.Cloud Hospital 1406 6th Ave N, St. Cloud 56303, MN, USA.
² Department of Surgery, University of Texas Health Science Center at Houston 6410 Fannin Street, Houston 77030, TX, USA.
³ Burn Center, United States Army Institute of Surgical Research 3698 Chambers Pass STE B, JBSA Ft. Sam Houston 78234, TX, USA.
⁴ Department of Anesthesiology, Brooke Army Medical Center 3551 Roger Brooke Dr, JBSA Ft. Sam Houston 78234, TX, USA.
⁵ Department of Trauma, Brooke Army Medical Center 3551 Roger Brooke Dr, JBSA Ft. Sam Houston 78234, TX, USA.
⁶ Department of Surgery, Uniformed Services University of The Health Sciences 4301 Jones Bridge Rd, Bethesda 20814, MD, USA.

PMID: 36660265
PMCID: PMC9845808

Abstract

Introduction: Atrial fibrillation is associated with increased morbidity and mortality in critically ill patients. Few studies have specifically examined this arrhythmia in burn patients. Given the significant clinical implications of atrial fibrillation, understanding the optimal management strategy of this arrhythmia in burn patients is important. Consequently, the purpose of this study was to examine rate- and rhythm-control strategies in the management of new onset atrial fibrillation (NOAF) and assess their short term outcomes in critically ill burn patients.

Methods: We identified all patients admitted to our institution's burn intensive care unit between January 2007 and May 2018 who developed NOAF. Demographic information and burn injury characteristics were captured. Patients were grouped into two cohorts based on the initial pharmacologic treatment strategy: rate-(metoprolol or diltiazem) or rhythm-control (amiodarone). The primary outcome was conversion to sinus rhythm. Secondary outcomes included relapse or recurrence of atrial fibrillation, drug-related adverse events, and complications and mortality within 30 days of the NOAF episode.

Results: There were 68 patients that experienced NOAF, and the episodes occurred on median days 8 and 9 in the rate- and rhythm-control groups, respectively. The length of the episodes was not significantly different between the groups. Conversion to sinus rhythm occurred more often in the rhythm-control group (P = 0.04). There were no differences in the incidences of relapse and recurrence of atrial fibrillation, and the complications and mortality between the groups. Hypotension was the most common drug-related adverse event and occurred more frequently in the rate-control group, though this difference was not significant.

Conclusions: Conversion to sinus rhythm occurred more often in the rhythm-control group. Outcomes were otherwise similar in terms of mortality, complications, and adverse events. Hypotension occurred less frequently in the rhythm-control group, and although this difference was not significant, episodes of hypotension can have important clinical implications. Given these factors, along with burn patients having unique injury characteristics and a hypermetabolic state that may contribute to the development of NOAF, when choosing between rate- and rhythm control strategies, rhythm-control with amiodarone may be a better choice for managing NOAF in burn patients.

Keywords: Burns; new onset atrial fibrillation; rate-control; rhythm-control.