Atrial fibrillation (AFib) is an irregular and often rapid heart rhythm that can increase the risk of stroke, heart failure, and other complications. In critical care, healthcare providers work to control the heart rate, restore normal sinus rhythm when feasible, and administer treatments to prevent complications like blood clots. The treatment of AFib in this setting typically involves heart rate reducing agents that allow the patient to convert to sinus rhythm. Close monitoring and specialized interventions are integral to managing atrial fibrillation effectively.
Atrial Fibrillation
New-Onset Atrial Fibrillation (NOAF) in Critical Illness
New-Onset Atrial Fibrillation (NOAF) in Critical Illness
- Systemic Inflammatory Response Syndrome (SIRS), a highly prevalent, nonspecific, inflammatory state, is primarily seen in acute care and critical care settings.1,2
- Non-infectious causes such as trauma, burns and major surgery predominate over infectious causes (sepsis) for both US and worldwide hospital and ICU admissions and for adult emergency department visits.1,2
- SIRS is a key indicator of patients at high risk for end-organ dysfunction and increased mortality.3
- Supraventricular tachyarrhythmias and atrial fibrillation are common and serious complications in critical care.4,5
New-onset atrial fibrillation (NOAF) is a frequent arrhythmia in critically ill patients, particularly with infectious or non-infectious SIRS.
- The critical care setting is characterized by a state of "sympathetic overdrive," with high levels of circulating catecholamines, which serve as a compensatory mechanism to maintain organ perfusion but can lead to NOAF.6
- Persistent tachycardia and adrenergic overstimulation can lead to cardiac dysfunction and worsen outcomes.6,7
- Longer ICU stays, prolonged hospitalization, increased hospital mortality, and a higher risk of stroke or myocardial infarction are observed in patients who develop NOAF.4,8
References:
- Horeczko T, Green JP, Panacek EA. Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department. West J Emerg Med. 2014 May;15(3):329-36. doi: 10.5811/westjem.2013.9.18064.
- Baddam S, Burns B. Systemic Inflammatory Response Syndrome. [Updated 2025 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Nasir N, Jamil B, Siddiqui S, Talat N, Khan FA, Hussain R. Mortality in Sepsis and its relationship with Gender. Pak J Med Sci. 2015 Sep-Oct;31(5):1201-6. doi: 10.12669/pjms.315.6925
- Moss TJ, Calland JF, Enfield KB, et al. New-Onset Atrial Fibrillation in the Critically Ill. Crit Care Med. 2017 May;45(5):790-797. doi: 10.1097/CCM.0000000000002325.
- Kuipers, S.; Klouwenberg, P.M.K.; Cremer, O.L. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: A systematic review. Crit. Care 2014, 18, 688.
- Guarracino F, Cortegiani A, Antonelli M, et al. The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement. J Anesth Analg Crit Care. 2023 Oct 23;3(1):41. doi: 10.1186/s44158-023-00126-2.
- Bosch, N.A.; Cimini, J.;Walkey, A.J. Atrial Fibrillation in the ICU. Chest 2018, 154, 1424–1434.
- Klein Klouwenberg PM, Frencken JF, Kuipers S, et.al *. Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study. Am J Respir Crit Care Med. 2017 Jan 15;195(2):205-211. doi: 10.1164/rccm.201603-0618OC.