Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review

Yoshida, Takuo; Fujii, Tomoaki; Uchino, Shigehiko; Takinami, Masanori

doi:10.1186/s40560-015-0085-4

Cited by 85 publications

(94 citation statements)

References 69 publications

(107 reference statements)

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“…In the current study, AF was more prevalent in males with age > 65 years as shown previously in both ICU patients and in the general population [2, 4, 11]. This was independent of etiology: in trauma patients, there was no incidence of AF in females.…”

Section: Discussionsupporting

confidence: 86%

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Duarte

Leichtweis

Andriolo

et al. 2017

Critical Care Research and Practice

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Background Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Method Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Results Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. Conclusions In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality.

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Section: Discussionsupporting

confidence: 86%

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Duarte

Leichtweis

Andriolo

et al. 2017

Critical Care Research and Practice

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“…(18) Recent reviews exploring the management of atrial fibrillation in the ICU have concluded that there is insufficient evidence to select one pharmacologic agent over another in most circumstances. (5,6,19)…”

Section: Discussionmentioning

confidence: 99%

“…Several small studies have attempted to compare various rate and rhythm control agents with mixed results. (5,6) In a recent retrospective, propensity-matched analysis of a large administrative database, calcium channel blockers (CCB) were identified as the most frequently used class of intravenous pharmacologic agents for atrial fibrillation during sepsis. (7) Beta-blockers, however, were associated with improved hospital mortality when compared with CCBs, digoxin, and amiodarone.…”

Section: Introductionmentioning

confidence: 99%

Management of Atrial Fibrillation with Rapid Ventricular Response in the Intensive Care Unit

Moskowitz

Chen

Cooper

et al. 2017

Shock

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Purpose Atrial fibrillation with rapid ventricular response (RVR) is common during critical illness. In this study, we explore the comparative effectiveness of three commonly used drugs (metoprolol, diltiazem, and amiodarone) in the management of atrial fibrillation with RVR in the intensive care unit (ICU). Methods Data pertaining to the first ICU admission were extracted from the Medical Information Mart for Intensive Care (MIMIC) III database. Patients who received one of the above pharmacologic agents while their heart rate was >110bpm and had atrial fibrillation documented in the clinical chart were included. Propensity score weighting using a generalized boosted model was used to compare medication failure rates (second agent prior to termination of RVR). Secondary outcomes included time to control, control within 4-hours, and mortality. Results 1,646 patients were included: 736 received metoprolol, 292 received diltiazem, and 618 received amiodarone. Compared to those who received metoprolol, failure rates were higher amongst those who received amiodarone (OR 1.39, 95%CI 1.03–1.87, p=0.03) and there was a trend towards increased failure rates in patients who received diltiazem (OR 1.35, CI 0.89–2.07, p=0.16). Amongst patients who received a single agent, patients who received diltiazem were less likely to be controlled at 4-hours than those who received metoprolol (OR 0.64, CI 0.43–097, p=0.03). Initial agent was not associated with in-hospital mortality. Conclusions In this study, metoprolol was the most commonly used agent for atrial fibrillation with RVR. Metoprolol had a lower failure rate than amiodarone and was superior to diltiazem in achieving rate control at 4-hours.

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“…Rhythm 262 control and rate control have both been used as outcome measures in the few 263 therapeutic studies available in the literature, although there is no clear guidance 264 whether rate or rhythm control is preferable to influence overall outcome of critical 265 illness (Liu et al 2016). 266 In fact, a recent systematic review on new-onset AF in non-cardiac critically ill patients 267 identified only five studies, which compared different treatment strategies for new-268 onset AF in critically ill patients (Yoshida et al 2015). However, only one of the studies 269 was a randomised controlled trial.…”

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confidence: 99%

Peer Review #3 of "Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey (v0.1)"

Champion¹

2017

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Background: New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Although evidence base and expert consensus opinion for management have been summarised in several international guidelines, no specific considerations for critically ill patients have been included. We aimed to establish current practice of management of critically ill patients with new-onset AF. Methods: We designed a short user-friendly online questionnaire. All members of the Intensive Care Society were invited via email containing a link to the questionnaire, which comprised 21 questions. The online survey was conducted between November 2016 and December 2016. Results: The response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) would start intervention on patients with fast new-onset AF and stable blood pressure at a heart rate between 120 and 139 beats/min. However, 34.8% of participants would treat all patients who developed new-onset fast AF. Amiodarone and beta-blockers (80.9% and 11.6% of answers) were the most commonly used anti-arrhythmics. 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. 85.4% of participants would consider taking part in a clinical trial investigating treatment of new-onset fast AF in the critically ill. Discussion: Our results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, particularly with regard to anti-arrhythmics and anticoagulation used. Amongst intensivists, there is a substantial interest in research for management of new-onset AF in critically ill patients.Manuscript to be reviewed 22 Abstract: 23 24 Background: 25 New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. 26 Although evidence base and expert consensus opinion for management have been 27 summarised in several international guidelines, no specific considerations for critically ill 28 patients have been included. We aimed to establish current practice of management of 29 critically ill patients with new-onset AF.30 Methods: 31 We designed a short user-friendly online questionnaire. All members of the Intensive 32 Care Society were invited via email containing a link to the questionnaire, which 33 comprised 21 questions. The online survey was conducted between November 2016 34 and December 2016.35 Results: 36 The response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked 37 in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) 38 would start intervention on patients with fast new-onset AF and stable blood pressure 39 at a heart rate between 120 and 139 beats/mi...

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Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review

Cited by 85 publications

References 69 publications

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Management of Atrial Fibrillation with Rapid Ventricular Response in the Intensive Care Unit

Peer Review #3 of "Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey (v0.1)"

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