Epidemiology and pharmacological management of new onset atrial fibrillation in critically ill adults: A multicentre observational study

Objective: We aimed to determine the incidence of new onset atrial fibrillation (NOAF) in a cohort of intensive care unit (ICU) patients and, further, identify commonly utilised pharmacological strategies for its management in patients with and without sepsis. Design: A multicentre, retrospective observational study was conducted. Setting: Twelve ICUs in Queensland, Australia. Participants: Adult patients, excluding those with cardiothoracic surgical diagnoses, admitted to a participating ICU from 2015 to 2021. Main outcome measures: Main outcome measures included the incidence of NOAF in ICU, association of NOAF with illness severity and outcomes, cardiac rhythm at ICU discharge, and incidence of pharmacological intervention for NOAF in the ICU. Results: NOAF occurred in 8.4 % of included ICU admissions, and was associated with higher illness severity, length of stay, and mortality. The majority of patients who experienced NOAF and survived their ICU stay were discharged from the ICU in a sinus rhythm (68.6 %). Patients with sepsis-associated NOAF were more likely to be in a sinus rhythm at ICU discharge than patients with NOAF without sepsis (72.2 vs 65.7 %). Amiodarone was frequently (50.4 %) prescribed to patients both with (56.5 %) and without (45.3 %) sepsis. Conclusion: NOAF was common amongst patients admitted to the ICU, and amiodarone is commonly prescribed. Future studies are required to determine the optimal short- and long-term management strategies for NOAF complicating critical illness.