الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Sepsis is common and often fatal, representing a major public health problem. Estimates of the incidence of sepsis vary widely due to differences in case ascertainment, ranging from 66 to 300 per 100000 population in the developed world. However, there is consensus that the incidence is increasing, driven by an ageing population with multiple co-morbidities, increased use of immunosuppressive therapy and high-risk interventions.
Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations .Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction, autonomic dysfunction and, most likely also, by impairment and involvement of the cardiac conduction system.
AF is the most common type of cardiac arrhythmia with the ever-ageing population, the prevalence of AF is also increasing. In AF, the upper chambers of the heart do not function correctly as a result of abnormal electrical signaling.
Epidemiologically, most septic patients who developed new atrial fibrillation were in septic shock. Pneumonia was shown to be the most likely source of infection in septic patients with new atrial fibrillation.
NOAF events in septic patients indicate a diversity of clinical strategies. It should be considered as a sign of the early SIRS. It follows that patient care may be enhanced by continuous cardiovascular monitoring and simple daily 12-lead ECG in addition to clinical exams and laboratory findings.
Second, it may to be an important prognostic sign. It is correlated with increasing mortality and new neurologic events. Thus, keeping it in mind, the heart-rate variability performance might become a relevant part of the clinical assessment in potentially septic patients.
A new AF event needs to be treated by electrical (synchronized shock) or pharmacological (amiodarone) cardioversion. It should be delayed by antiarrhythmic therapy such as â-blockers or Ca channel blockers Amiodarone has a lesser negative inotropic and proarrhythmic effect and was found to be the single most frequently used drug for controlling arrhythmic tachycardia.
Importantly, the inability to restore sinus rhythm was strongly correlated with ICU mortality. It should be well understood that the inability to restore sinus rhythm could compromise acutely patient’s haemodynamic status and even increase mortality, though the restoration of sinus rhythm in septic patients does not automatically imply an improvement in clinical outcome.
The priorities in therapy of arrhythmias in sepsis and septic shock are to prevent diastolic heart failure, post tachycardic systolic heart failure and dilatation. This goes hand in hand with the maintenance of stroke volume, cardiac output and myocardial Do2/ Vo2. Persistent arrhythmia may potentiate microthrombi formation within the heart, in relation to systolic function, the size of atria, ventricles and valvular disease. This issue has not been fully clarified in the critically ill yet. Minute silent brain infarctions related to cognitive dysfunction have been reported on NMR, even in fully anticoagulated patients with chronic AF.
In our meta-analysis, we found that NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease.
Also, we found that NOAF in sepsis patients is significantly associated with increased risk of ICU. In hospital, and After hospital discharge mortality, as well as , increased risk of developing ischemic stroke.