[Infection, sepsis and cardiac arrhythmia]

In clinical practice, the occurrence of arrhythmias in a critical ill patient is often assumed to be due to underlying infection or sepsis. This relationship has been suggested by both case reports and textbooks of Internal Medicine. Two scenarios are deemed possible: The occurrence of "preexisting" arrhythmias in susceptible patients (those with an arrhythmogenic substrate, e.g. a myocardial infarction scar) and the occurrence of arrhythmias mediated in some way through the infection/sepsis in otherwise unsusceptible patients. The present overview portrays the scarcity of data and shows that neither scenario is supported by firm data. While sinus tachycardia is among the spectrum of expected abnormalities during infection or sepsis, bradycardia may be observed in selected cases. This seems to occur relatively frequently in patients with fungemia.