Beyond the first episode: predictors of NOAF recurrence after ICU stay

Introduction New-onset atrial fibrillation (NOAF) is common among critically ill patients and is associated with increased morbidity and mortality. Although often considered transient, many patients experience recurrence after discharge. Identifying predictors of atrial fibrillation (AF) recurrence is essential to improve risk stratification, follow-up, and management strategies. Purpose This study aimed to determine independent predictors of NOAF recurrence and their prognostic significance. Methods This retrospective, single-centre study included consecutive Intensive Care Unit (ICU) patients who developed NOAF during the ICU stay. Clinical, laboratory, and echocardiographic data were collected from hospital records. A multivariate Cox regression analysis was performed to identify independent predictors of AF recurrence. Results A total of 140 patients with NOAF were included, 65% of whom were male, with a median age of 70 years. Cardiovascular comorbidities were frequent, including hypertension (67.1%), dyslipidaemia (38.6%), and diabetes (32.1%). Most patients were admitted to the ICU due to sepsis or septic shock (75.7%), with a median SOFA score at admission of 7. A rhythm-control strategy was adopted in 87.2% of patients, with AF recurrence observed in 48.6%. ICU mortality was 32%. The median CHA₂DS₂-VASc score was 3, and at ICU discharge 27.9% of patients were anticoagulated. Regarding antiarrhythmic therapy, 22.9% were discharged on amiodarone, 8.6% on beta-blockers, and 7.9% on digoxin. During follow-up, 43.6% of patients experienced AF recurrence, 7.9% died from cardiovascular causes, 37.9% from non-cardiovascular causes, 5–7% were hospitalised for cardiovascular events, and 2.1% suffered a stroke (Table 1). In the multivariate analysis, only amiodarone use at discharge was independently associated with a reduced risk of AF recurrence during follow-up (HR: 0.112, 95% CI 0.015–0.929, p = 0.042), after adjustment for age, diabetes, dyslipidaemia, obesity, obstructive sleep apnoea, and chronic kidney disease. Conclusion In this cohort, AF recurrence occurred in nearly half of the patients during both ICU stay and follow-up. Importantly, amiodarone use at discharge was independently associated with a lower risk of AF recurrence, suggesting a potential protective effect. These findings highlight the burden of NOAF in critically ill patients and the need for tailored rhythm management strategies.