Abstract
BackgroundNew-onset atrial fibrillation (AF) in critically ill patients is reportedly associated with poor outcomes. However, epidemiological data in intensive care units (ICUs) after new-onset AF identification are lacking. This study aimed to describe the clinical course after the identification of new-onset atrial fibrillation.Methods This prospective cohort study of 32 ICUs in Japan during 2017-2018 enrolled adult patients with new-onset AF. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions, transition of cardiac rhythms, adverse events, and in-hospital death and stroke.Results The incidence of new-onset AF in the ICU was 2.9% (423 patients). At the AF onset, the mean atrial pressure decreased, and the heart rate increased. Sinus rhythm returned spontaneously in 84 patients (20%), and 328 patients (78%) were treated with pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). In total, 173 (40%) patients were treated with anticoagulants. Adverse events were more frequent in nonsurvivors than in survivors (bleeding: 14% vs 5%; p = 0.002, arrythmia other than AF: 6% vs 2%; p = 0.048). There were 92 (22%) and 15 patients (4%) patients who continued to have AF at 48 hours and 168 hours after onset, respectively. The hospital mortality rate of those patients were 32% and 60%, respectively. The overall hospital mortality was 26%, and the incidence of in-hospital stroke was 4.5%.Conclusions Although the proportion of patients continued to have AF within 168 hours decreased with various treatments, these patients were at a high risk of death. Moreover, adverse events occurred more frequently in nonsurvivors than in survivors. Further research to assess the management of new-onset AF in critically ill patients is strongly warranted.
Impaired heart rate recovery is associated with new-onset atrial fibrillation: a prospective cohort study
