Electrocardiographic Findings and Incidence of New-onset Atrial Arrhythmia among Patients with Severe Leptospirosis who Underwent Veno-venous Extracorporeal Membrane Oxygenation: A Single Center Cross-sectional Study

Abstract

Background. Leptospirosis is a zoonotic disease caused by Leptospira species that remains endemic in the Philippines. In severe cases, patients present with multiple organ system failure such as acute renal failure and acute respiratory distress syndrome (ARDS) requiring renal replacement therapy, mechanical ventilation, and novel treatment modalities such as extracorporeal membrane oxygenation (ECMO). Cardiac complications such as atrial arrhythmia also occur in cases of severe leptospirosis leading to worse outcomes. There is limited data on the electrocardiographic findings in patients with severe leptospirosis undergoing ECMO along with the incidence of new-onset atrial arrhythmia while managed on this intervention with unique hemodynamic system.

Objective. This study aims to determine the baseline electrocardiographic (ECG) findings and incidence of new-onset atrial arrhythmia among patients with severe leptospirosis during veno-venous (V-V) ECMO.

Methods. A cross-sectional study among patients with severe leptospirosis and ARDS who underwent V-V ECMO was conducted at the National Kidney and Transplant Institute. Primary outcome was defined as the presence of new-onset atrial arrhythmia during ECMO. Secondary outcomes included in-hospital mortality, length of hospital stay, duration of mechanical ventilation, duration of ECMO, and development of thrombotic events.

Results. Among 31 patients included, 90.3% (n = 28) were male and median age was 33.48 ± 10.0 years. The most common ECG finding was atrial fibrillation with an incidence of 32.3% (n = 10), half of which occurred before ECMO, while the other half were noted after cannulation. During ECMO, the incidence of newonset atrial arrhythmia was found to be at 19.4% (n = 6). Patients with new-onset atrial arrhythmia had higher white blood cell, total bilirubin, BUN, creatinine, APACHE-II scores, use of dopamine, lower platelet count and lower PaO2/FiO2 ratio. Two patients (33.33%) died among those with new-onset atrial arrhythmia, while five patients (20%) died in the other group. There was no noted thrombotic events such as stroke among the groups and no difference on the duration on mechanical ventilator, ECMO and hospital stay.

Conclusion. New-onset atrial arrhythmias are the most common ECG findings during V-V ECMO among patients with severe leptospirosis with an earlier occurrence in this population post-cannulation. Atrial fibrillation is noted as the most common electrocardiographic finding in this population. This study demonstrated a higher mortality among patients with new-onset atrial arrhythmia during ECMO for severe leptospirosis, with no statistical difference.