Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study

Abstract

Background New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study. Methods We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness. Results Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables. Conclusions We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.

Triggers for new-onset atrial fibrillation in critically ill patients

“…This remodelling alters the mechanical and anatomic structure of the atria (the substrate) such that its propensity for development and maintenance of AF is increased (an arrhythmogenic substrate). Numerous risk factors contribute to the development of NOAF during critical illness, with multiple mechanisms that encourage remodelling and ectopy (Bedford et al, 2021).…”