Key result
Rhythm-control therapy for new-onset AF in critically ill patients was associated with sinus rhythm restoration (HR 1.46; 95% CI 1.16-1.85), but had numerically higher hospital mortality.
Why the study?
Whether rhythm-control therapy can achieve sinus rhythm restoration in critically ill patients with new-onset AF is unknown.
Does rhythm-control therapy improve sinus rhythm restoration in critically ill patients with new-onset atrial fibrillation?
Observational (n=423)
Yes
Does rhythm-control therapy improve sinus rhythm restoration in critically ill patients with new-onset atrial fibrillation?
In critically ill patients with new-onset atrial fibrillation, rhythm-control therapy is associated with successful sinus rhythm restoration but may be linked to higher hospital mortality, highlighting the need for randomized interventional studies.
Caution against routine rhythm control in critically ill new-onset AF; leaves open whether it improves outcomes, warranting RCTs.
BACKGROUND: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients. METHODS: This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration. RESULTS: Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16-1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09). CONCLUSIONS: Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.
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Yoshida et al. (2021) conducted an observational in New-onset atrial fibrillation (n=423). Rhythm-control therapy vs. No rhythm-control therapy was evaluated on Sinus rhythm restoration (HR 1.46, 95% CI 1.16-1.85). Rhythm-control therapy for new-onset AF in critically ill patients was associated with sinus rhythm restoration (HR 1.46; 95% CI 1.16-1.85), but had numerically higher hospital mortality.
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