Atrial fibrillation detected initially during acute medical illness: A systematic review

Abstract

Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness. Data sources: Medline, Embase and Cochrane Central to September 2017. Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge. Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge. Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis ( I2=99%). In post-hoc meta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%. Conclusions: The incidence of atrial fibrillation with medical illness may be as high as 44%, with higher estimates in reports using continuous ECG monitoring. Within 5 years following hospital discharge, atrial fibrillation recurrence is documented in approximately half of patients; however, the true rate may be higher. Protocol registration PROSPERO CRD42016043240

Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow‐up cohort study

“…AFOTS is detected with variable frequency . In our previous work, we reviewed the incidence of AFOTS and the recurrence of AF following an acute medical stressor . We found that AFOTS was detected following medical illness (eg, sepsis, pneumonia) with an incidence of 1% to 44% .…”

“…In our previous work, we reviewed the incidence of AFOTS and the recurrence of AF following an acute medical stressor . We found that AFOTS was detected following medical illness (eg, sepsis, pneumonia) with an incidence of 1% to 44% . Similarly, incidence estimates of AFOTS following non‐cardiac surgery range from 1% to 35% .…”

Atrial fibrillation occurring initially during acute medical illness: the heterogeneous nature of disease, outcomes and management strategies

“…3 In this issue of the journal, a systemic review and metaanalysis study summarises the available literature on this topic, reporting the incidence and long-term recurrence of AF that has occurred among these patients with other underlying medical conditions, ranging from the ICU and beyond. 4 McIntyre et al 4 show that the reported incidence of AF detected initially during acute medical illness ranges from 1% to 44%, with a higher incidence among patients from the ICU compared with those not from the ICU (3-44% vs. 1-22%). Approximately half of the studies subjects had recurrent AF at 5 years of follow-up.…”

“…Approximately half of the studies subjects had recurrent AF at 5 years of follow-up. 4 Nevertheless, the true rates of incidence and recurrence of AF could be higher, given that continuous ECG monitoring reveals more occult AF and this approach of arrhythmia monitoring was not systematically conducted across the summarised studies. 4 As previously reported, the prevalence of transient AF accounts for 7.8-10.0% among all types of AF.…”

“…4 Nevertheless, the true rates of incidence and recurrence of AF could be higher, given that continuous ECG monitoring reveals more occult AF and this approach of arrhythmia monitoring was not systematically conducted across the summarised studies. 4 As previously reported, the prevalence of transient AF accounts for 7.8-10.0% among all types of AF. 3,5 Approximately 50% of patients presenting with transient AF will revert spontaneously back to sinus rhythm during their hospital stay.…”