Atrial Fibrillation in the Setting of Acute Pneumonia: Not a Secondary Arrhythmia

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the setting of critically ill patients. Pneumonia, and in particular community-acquired pneumonia, is one of the most common causes of illness and hospital admission worldwide. This article aims to review the association between AF and acute diseases, with specific attention to pneumonia, from the pathophysiology to its clinical significance. Even though the relationship between pneumonia and AF has been known for years, it was once considered a transient bystander. In recent years there has been growing knowledge on the clinical significance of this arrhythmia in acute clinical settings, in which it holds a prognostic role which is not so different as compared to that of the so-called “primary” AF. AF is a distinct entity even in the setting of pneumonia, and acute critical illnesses in general, and it should therefore be managed with a guidelines-oriented approach, including prescription of anticoagulants in patients at thromboembolic risk, always considering patients’ individuality. More data on the significance of the arrhythmia in this setting will help clinicians to give patients the best possible care.

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

“…Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In some cases, even in the absence of prior history of AF, AF may occur during an acute illness 1 , 2 or may occur in a surgical setting, being more frequently documented after cardio-thoracic surgery (incidence around 30%), 3 but also in noncardiac surgical procedures. 4 In a recent study 5 the rate of postoperative AF (POAF) in the cardiac surgery setting was reported to approximate 20%, whilst in noncardiac surgery it was around 1%.…”

The epidemiology and mortality of patients with atrial fibrillation: a complex landscape

“…22,46 The interesting study by Zuin et al 30 was conducted before the COVID-19 pandemic that had a major impact on admission to hospitals for AF and AF management. 47 On the one hand, AF incidence increases in the setting of acute illnesses, 48,49 such as COVID-19, 50,51 and its pathogenesis involves a complex interplay between inflammation, prothrombotic state, hemodynamic changes, and sympathetic-vagal imbalances. On the other hand, electrophysiology procedures, as well as admissions and procedures for acute diseases, declined during the subsequent waves of COVID-19 in Italy [52][53][54] and in other European countries, 55 thus potentially accounting for a worsening of patient outcomes.…”