Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department
Abstract In critically ill patients with atrial fibrillation (AF), standard treatment algorithms might not be applicable. Emergency departments (ED) play a crucial role in implementing individualized treatment approaches. The aim of this study was to assess the association of lactate and cardioversi...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-025-85224-7 |
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| author | Sophie Gupta Sebastian Schnaubelt Julia Oppenauer Martin Lutnik Filippo Cacioppo Alexander Spiel Hans Domanovits Patrick Sulzgruber Jan Niederdöckl |
| author_facet | Sophie Gupta Sebastian Schnaubelt Julia Oppenauer Martin Lutnik Filippo Cacioppo Alexander Spiel Hans Domanovits Patrick Sulzgruber Jan Niederdöckl |
| author_sort | Sophie Gupta |
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| description | Abstract In critically ill patients with atrial fibrillation (AF), standard treatment algorithms might not be applicable. Emergency departments (ED) play a crucial role in implementing individualized treatment approaches. The aim of this study was to assess the association of lactate and cardioversion success rates in AF patients presenting to an ED. This was a retrospective single-center study analyzing 3535 AF episodes between 2012 and 2022. The main outcome was cardioversion (CV) to sinus rhythm (SR) depending on serum lactate levels (mmol/L). Lactate levels were divided into quintiles (lac < 1.1, 1.1–1.3, 1.4–1.7, 1.8–2.3 and > 2.3 mmol/L). Overall CV success declined with rising lactate levels (SR: lac < 1.1 79% (n = 547), 1.1–1.3 76% (n = 579), 1.4–1.7 73% (n = 562), 1.8–2.3 66% (n = 447), > 2.3 mmol/L 61% (n = 393); p < 0.001). Electrical CV (eCV) was conducted in 1021 (SR 95%), medical CV (mCV) in 706 (SR: 72%), facilitated CV in 523 (SR: 88%) and spontaneous conversion was observed in 591 (46% of all patients without treatment) cases. ECV was effective independent of lactate levels (SR: lac < 1.1 96% (n = 225), 1.1–1.3 93% (n = 253), 1.4–1.7 97% (n = 228), 1.8–2.3 92% (n = 154), > 2.3 mmol/L 95% (n = 106); p = 0.716). However, for mCV, conversion success decreased with increasing lactate levels (SR: lac < 1.1 84% (n = 95), 1.1–1.3 80% (n = 109), 1.4–1.7 75% (n = 115), 1.8–2.3 67% (n = 93), > 2.3 mmol/L 59% (n = 97); p < 0.001). Overall cardioversion success was less likely with rising lactate levels; especially medical cardioversion success rates decreased. Therefore, AF in critically ill may benefit from either electrical cardioversion, treatment of the underlying condition, or primary rate control. |
| format | Article |
| id | doaj-art-bf3144d9b992431399b7b55ba88b5f5b |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-bf3144d9b992431399b7b55ba88b5f5b2025-01-12T12:20:27ZengNature PortfolioScientific Reports2045-23222025-01-011511710.1038/s41598-025-85224-7Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency departmentSophie Gupta0Sebastian Schnaubelt1Julia Oppenauer2Martin Lutnik3Filippo Cacioppo4Alexander Spiel5Hans Domanovits6Patrick Sulzgruber7Jan Niederdöckl8Department of Emergency Medicine, Medical University of ViennaDepartment of Emergency Medicine, Medical University of ViennaDepartment of Emergency Medicine, Medical University of ViennaDepartment of Clinical Pharmacology, Medical University of ViennaDepartment of Emergency Medicine, Medical University of ViennaDepartment of Emergency Medicine, Clinic Ottakring, Vienna Healthcare GroupDepartment of Emergency Medicine, Medical University of ViennaDivision of Cardiology, Department of Internal Medicine II, Medical University of ViennaDepartment of Emergency Medicine, Medical University of ViennaAbstract In critically ill patients with atrial fibrillation (AF), standard treatment algorithms might not be applicable. Emergency departments (ED) play a crucial role in implementing individualized treatment approaches. The aim of this study was to assess the association of lactate and cardioversion success rates in AF patients presenting to an ED. This was a retrospective single-center study analyzing 3535 AF episodes between 2012 and 2022. The main outcome was cardioversion (CV) to sinus rhythm (SR) depending on serum lactate levels (mmol/L). Lactate levels were divided into quintiles (lac < 1.1, 1.1–1.3, 1.4–1.7, 1.8–2.3 and > 2.3 mmol/L). Overall CV success declined with rising lactate levels (SR: lac < 1.1 79% (n = 547), 1.1–1.3 76% (n = 579), 1.4–1.7 73% (n = 562), 1.8–2.3 66% (n = 447), > 2.3 mmol/L 61% (n = 393); p < 0.001). Electrical CV (eCV) was conducted in 1021 (SR 95%), medical CV (mCV) in 706 (SR: 72%), facilitated CV in 523 (SR: 88%) and spontaneous conversion was observed in 591 (46% of all patients without treatment) cases. ECV was effective independent of lactate levels (SR: lac < 1.1 96% (n = 225), 1.1–1.3 93% (n = 253), 1.4–1.7 97% (n = 228), 1.8–2.3 92% (n = 154), > 2.3 mmol/L 95% (n = 106); p = 0.716). However, for mCV, conversion success decreased with increasing lactate levels (SR: lac < 1.1 84% (n = 95), 1.1–1.3 80% (n = 109), 1.4–1.7 75% (n = 115), 1.8–2.3 67% (n = 93), > 2.3 mmol/L 59% (n = 97); p < 0.001). Overall cardioversion success was less likely with rising lactate levels; especially medical cardioversion success rates decreased. Therefore, AF in critically ill may benefit from either electrical cardioversion, treatment of the underlying condition, or primary rate control.https://doi.org/10.1038/s41598-025-85224-7Atrial fibrillationDysrhythmiaCardioversionCritical illnessLactateEmergency medicine |
| spellingShingle | Sophie Gupta Sebastian Schnaubelt Julia Oppenauer Martin Lutnik Filippo Cacioppo Alexander Spiel Hans Domanovits Patrick Sulzgruber Jan Niederdöckl Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department Scientific Reports Atrial fibrillation Dysrhythmia Cardioversion Critical illness Lactate Emergency medicine |
| title | Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| title_full | Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| title_fullStr | Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| title_full_unstemmed | Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| title_short | Analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| title_sort | analyzing the association of critical illness and cardioversion success in patients with atrial fibrillation at the emergency department |
| topic | Atrial fibrillation Dysrhythmia Cardioversion Critical illness Lactate Emergency medicine |
| url | https://doi.org/10.1038/s41598-025-85224-7 |
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