High-Sensitivity Estimate of the Incidence of New-Onset Atrial Fibrillation in Critically Ill Patients

Abstract

Objective: To estimate the incidence of new-onset atrial fibrillation in critically ill patients. Design: Prospective cohort. Setting: Medical-surgical ICU. Subjects: Consecutive patients without a history of atrial fibrillation but with atrial fibrillation risk factors. Interventions: Electrocardiogram patch monitor until discharge from hospital or up to 14 days. Measurements and Main Results: A total of 249 participants (median age of 71 yr [interquartile range] 64–78 yr; 35% female) completed the study protocol of which 158 (64%) were admitted to ICU for medical illness, 78 (31%) following noncardiac surgery, and 13 (5%) with trauma. Median Acute Physiology and Chronic Health Evaluation II score was 16 (interquartile range, 12–22). Median duration of patch electrocardiogram monitoring, ICU, and hospital lengths of stay were 6 (interquartile range, 3–12), 4 (interquartile range, 2–8), and 11 days (interquartile range, 5–23 d), respectively. Atrial fibrillation ≥ 30 seconds was detected by the patch in 44 participants (17.7%), and three participants (1.2%) had atrial fibrillation detected clinically after patch removal, resulting in an overall atrial fibrillation incidence of 18.9% (95% CI, 14.2–24.3%). Total duration of atrial fibrillation ranged from 53 seconds to the entire monitoring time. The proportion of participants with ≥1 episode(s) of ≥6 minute, ≥1 hour, ≥12 hour and ≥24 hour duration was 14.8%, 13.2%, 7.0%, and 5.3%, respectively. The clinical team recognized only 70% of atrial fibrillation cases that were detected by the electrocardiogram patch. Conclusions: Among patients admitted to an ICU, the incidence of new-onset atrial fibrillation is approximately one in five, although approximately one-third of cases are not recognized by the clinical team.

Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*

“…1). The median age was 62 years (IQR, 49-72), and SMS-ICU was 14 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) at ICU admission (Table 1). Most common comorbidities were arterial hypertension (46%), diabetes mellitus (28%), and ischemic heart disease (14%) (Table 1).…”

“…The most used interventions to correct modifiable factors included fluid bolus 19% (95% CI, 16-23), magnesium 16% (13)(14)(15)(16)(17)(18)(19)(20), and potassium 15% (12-19) (Fig. 2).…”

“…2). Amiodarone 51% (47-55), beta-1 selective blockers 34% (30)(31)(32)(33)(34)(35)(36)(37)(38), calcium channel blockers 4% (2-6), and digoxin 16% (12)(13)(14)(15)(16)(17)(18)(19) were the most frequently used pharmacological agents (Fig. 2; and Supplemental Table 14, http://links.lww.com/CCM/H333).…”

COVID-19 and AF

“…New-onset AF is frequently detected in patients hospitalized for another concern. We prospectively estimated the incidence of new-onset AF in intensive care unit patients at 18.9% (95% CI: 14.2%-24.3%) ( 2 ), much higher than the Musikantow et al group ( 1 ). This may be explained by acuity or by the use of continuous electrocardiogram monitoring with AF detection algorithms.…”

Treatments of new‐onset atrial fibrillation in critically ill patients: a systematic review with meta‐analysis

“…[4][5][6] Studies have demonstrated that new-onset atrial fibrillation (NOAF) is frequently observed in hospitalised patients with acute and critically illness. [7][8][9] Three main therapeutic approaches exist in the management of AF including: (1) rhythm control, (2) rate control and (3) evaluating the need for anticoagulant therapy. 10,11 Most antiarrhythmics have well-known serious cardiac and non-cardiac adverse effects.…”