Key result
Sepsis-associated AF lacks standardized guidelines and requires large-scale trials to define evidence-based management protocols.
Why the study?
In contrast to primary AF, no standardized guidelines have been established for sepsis-associated atrial fibrillation to guide management despite its substantial morbidity and mortality.
This review highlights the critical need for standardized, evidence-based protocols for managing sepsis-associated atrial fibrillation, given its high morbidity and complex anticoagulation challenges.
Sepsis-associated AF management warrants caution without guidelines; leaves open optimal rate control and anticoagulation strategies pending large trials.
Sepsis-associated atrial fibrillation (SAAF) is a common but serious complication in critically ill patients that is characterized by new-onset atrial fibrillation (AF) during sepsis. This secondary type of arrhythmia typically resolves with sepsis treatment but is associated with substantial morbidity and mortality, including prolonged hospital stays, high recurrence rates of AF, and increased risks of heart failure, stroke, and short-term and long-term mortality. In contrast to primary AF, no standardized guidelines have been established for SAAF. To support the development of evidence-based protocols, we conducted a comprehensive review to synthesize the current knowledge of SAAF. Here, we highlight the definition, incidence, and risk factors of SAAF and distinguish it from primary AF and other types of secondary AF, including postoperative and post–myocardial infarction AF. We also describe the multifactorial pathophysiologic mechanisms of SAAF involving systemic inflammation, cytokine release, autonomic dysfunction, myocardial injury, and hemodynamic stress. Key outcomes of patients with SAAF and other types of secondary AF are compared, including in-hospital mortality, long-term AF recurrence, and stroke risk. Furthermore, we discuss various management strategies for SAAF, including methods of rhythm control and rate control in patients with SAAF. Anticoagulation recommendations and challenges for patients with SAAF are highlighted, particularly with respect to thrombotic risk, bleeding risk, and anticoagulation use. We propose a process for anticoagulation decisions in SAAF, which are challenging due to the dynamic interplay between sepsis-induced coagulopathy and thromboembolic risk. Finally, we provide a summary of future research priorities to support large-scale, multicenter trials to define evidence-based protocols that are critical for improving outcomes in this high-risk population.
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Leslie et al. (2026) conducted a review in Sepsis-associated atrial fibrillation. Sepsis-associated atrial fibrillation was evaluated. Sepsis-associated atrial fibrillation is a serious complication lacking standardized guidelines, highlighting the need for large-scale trials to define evidence-based management protocols.
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