Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study.

OBJECTIVES: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN: Multicenter, prospective, inception cohort study. SETTING: Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.

Hemiballismus in hyperglycemia.

Diabetes may cause late complications in the CNS but certain lesions may also occur acutely in hyperglycemia. We describe a case of hyperosmolar non-ketotic syndrome and reversible hemichoreic dyskinesia with morphological changes in basal ganglia.

[Myotonic dystrophy type 1 - a rare cause of bradycardia in the young]. / Dystrophia myotonica typ 1 ovanlig orsak till bradykardi hos unga - Synkopeepisoder hos 24-årig kvinna visade sig bero på sjuk sinusknuta till följd av neuromuskulär sjukdom.

Myotonic dystrophy type 1 (Steinert's disease) is a rare but important cause of bradycardia in the young. Syncope is primarily considered to be caused by high-degree atrioventricular block II-III but may also be caused by sinus node dysfunction. Life-threatening ventricular arrhythmias do occur, and in cases with impaired systolic left ventricular function, indication for a primary preventive implantable cardiac defibrillator should be evaluated. All patients with myotonic dystrophy type 1 should undergo clinical assessment, 12-lead ECG, 24-hour Holter, and echocardiography annually. We here describe the case of a 24-year-old woman who received a pacemaker due to sinus arrests with syncope caused by myotonic dystrophy type 1.

[Hemichorea/hemiballism a rare complication of hyperglycemia]. / Hemikorea/hemiballism ­ ovanlig komplikation till hyperglykemi - Ofrivilliga rörelser hos patient med nydebuterad diabetes.

We present a case of hemichorea/hemiballism, a rare complication of hyperglycemia. Diagnosis is made clinically by signs of unilateral involuntary movements of the extremities combined with typical neuroradiological findings in the basal ganglia. Guidelines for treatment of the condition are lacking but in many cases correction for hyperglycemia is sufficient for full symptom relief. In other cases, symptomatic treatment with haloperidol and tetrabenazine can be used.