The Significance of Cardiac Arrhythmias in Septic ICU Patients

The review article published in this issue by Schwartz A et al [1] draws attention to the importance of cardiac arrhythmias and especially that of new-onset atrial fibrillation (AF) and the clinical outcome of septic patients. The incidence of this phenomenon varies in different reports, from 5.8% [2] to 31-40% [3-4].
Causes are numerous and different mechanisms have been described in the literature and by the authors of the review. Endotoxin induces tachycardia, increases the cardiac index, and reduces blood pressure and systemic vascular resistance without change in stroke volume [5]. Fluid administration results in a decrease in left ventricular ejection fraction and an increase in ventricular volumes even more than before the administration of fluid therapy [5].
An increased inflammatory response also plays an important role in pathogenesis of cardiac arrhythmias and dysfunction in septic patients. Increased plasma levels of C-reactive protein, IL-6 and TNF-α may contribute to the onset of AF in septic patients [1,6]. [More]