Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association

Abstract

Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient’s underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient’s capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient’s ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“… Acute Medical or Surgical Illness. Adapted with permission from Chyou et al 17 Copyright 2023 American Heart Association, Inc. AF indicates atrial fibrillation.…”

Medical Economic Consequences, Predictors, and Outcomes of Immediate Atrial Fibrillation Recurrence after Radiofrequency Ablation

“…Recently, the American Heart Association issued a scientific statement proposing the concept of "acute AF," which refers to AF occurring in the context of other disease episodes [28]. AF after cardiac surgery is a unique type of acute AF.…”

Colchicine attenuates the electrical remodeling of post-operative atrial fibrillation through inhibited expression of immune-related hub genes and stabilization of microtubules

“…As the most important secondary atrial fibrillation (AF), the pathogenic mechanisms of POAF include electrical remodeling, structural remodeling, Ca 2+ handling abnormalities and autonomic nervous system changes (4). Due to incomplete understanding of the pathogenesis of POAF, many of the proposed preventive approaches lack sufficient efficacy and are further complicated by complex interplay between the pre-existing physiological components and local and systemic inflammation may involve in the etiology of POAF (2,3,5,6). Acute inflammation is a major transient post-operative factor that may trigger POAF (2,5), particularly where excessive inflammation increases the atrial conduction heterogeneity (7).…”