Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study

Abstract BackgroundSustained new-onset atrial fibrillation (AF) is time-dependently associated with hospital mortality. However, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration in critically ill patients is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration in critically ill patients with new-onset AF.MethodsThis study is a post hoc analysis of the AFTER-ICU study, a prospective observational study of patients with new-onset AF in 32 Japan intensive care units. This study included patients with and without rhythm-control therapy with new-onset AF. A multivariable analysis was performed using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration.ResultsOf 423 patients with new-onset AF, 178 (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 hours after AF onset. Magnesium sulfate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16–1.85). The rhythm-control group had higher hospital mortality than the non-rhythm-control group (31% vs. 23%, P=0.09).ConclusionsRhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.Trial registrationUMIN-CTR UMIN000026401

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New-onset atrial fibrillation in critically ill patients – Implications for rhythm rather than rate control therapy?

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.04.078 ◽

2018 ◽

Vol 266 ◽

pp. 147-148 ◽

Cited By ~ 1

Author(s):

M. Balik

Keyword(s):

Atrial Fibrillation ◽

Critically Ill ◽

Rate Control ◽

Critically Ill Patients ◽

Control Therapy ◽

Onset Atrial Fibrillation ◽

New Onset

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Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02235-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masaaki Sakuraya ◽

Takuo Yoshida ◽

Yusuke Sasabuchi ◽

Shodai Yoshihiro ◽

Shigehiko Uchino

Keyword(s):

Atrial Fibrillation ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Anticoagulation Therapy ◽

Composite Outcome ◽

Clinical Prediction ◽

Post Hoc ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Purpose This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy. Method Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge. Results In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041). Conclusions We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017.

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