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Research Snapshot Theater: Cardiovascular, Adult VIII

Comparison of New-Onset Versus Preexisting Atrial Fibrillation in Critically Ill Septic Patients

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 02

  • Kate Harding, PharmD

    Ohio State University

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • Essilvo Sulejmani, PharmD

    The Ohio State University Wexner Medical Center, Ohio

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • BD

    Bruce Doepker, PharmD, BCPS

    Critical Care Specialty Practice Pharmacist
    The Ohio State University Wexner Medical Center

    Disclosure information not submitted.

  • JA

    Joshua Arnold, PharmD, BCCCP

    Critical Care Specialty Practice Pharmacist
    The Ohio State University Wexner Medical Center

    Disclosure information not submitted.

  • bm

    brookeAnne magrum, PharmD, BCCCP

    Critical Care Specialty Practice Pharmacist
    The Ohio State University Wexner Medical Center

    Disclosure information not submitted.

  • AS

    Adam Smith, PharmD, BCCCP

    Critical Care Specialty Practice Pharmacist
    The Ohio State University Wexner Medical Center

    Disclosure information not submitted.

  • AG

    Anthony Gerlach, PharmD, FCCM

    Ohio State University Wexner Medical Center, Ohio

    Disclosure information not submitted.

Introduction: New onset atrial fibrillation (NOAF) arises from stressors of critical illness, but its progression and clinical impact compared to pre-existing atrial fibrillation (PEAF) remain unclear. This study aimed to evaluate outcomes in critically ill septic patients with NOAF and PEAF.


Methods: This single-center retrospective cohort study evaluated adult septic patients who experienced AF during their index admission to the surgical, medical, or mixed ICUs. The primary outcome was the incidence of AF with rapid ventricular rate (RVR, heart rate ≥ 110 beats per minute (bpm) for ≥ 15 minutes. Secondary outcomes included highest heart rate (HR) within 48 hours of AF onset, achievement of rate control (HR < 110 bpm for ≥ 6 hours), return to normal sinus rhythm (NSR) for ≥ 24 hours, AF management strategies, major bleeding or ischemic events, therapeutic anticoagulation initiation, and AF recurrence. Statistical analyses were conducted via Fisher’s exact test for nominal data, T-test for normally distributed continuous data, and Mann-Whitney U test for non-normally distributed continuous data.


Results: Fifty-four NOAF patients and 76 PEAF patients were included. Patients had similar demographics (median age of 69 years, 60% male) and past medical history. NOAF patients experienced a longer time to AF onset (19 vs 7.5 hours, p=0.011) and a greater incidence of RVR (90.7% vs 72.4%, p=0.014). AF treatment was administered to 88.8% of NOAF patients and 73.7% of PEAF patients (p=0.033) and 79.6% and 46.1%, respectively, experienced a return to NSR (p < 0.001). In the NOAF group, there were higher rates of renal replacement therapy (25.9% vs 7.9%, p=0.007), more mechanical ventilation (46.3% vs 15.3%, p< 0.001), and increased vasopressor rates (0.21 vs 0.06 mcg/kg/minute norepinephrine dose equivalents, p=0.02) at AF onset despite similar SOFA scores (6 [4-10] vs 5 [4-7], p=0.13). Therapeutic anticoagulation initiation, major bleeding events, and ischemic events were similar between groups.


Conclusions: NOAF patients had a higher incidence of RVR but also showed signs of greater critical illness. These patients were also more likely to receive AF treatment and experience a return to NSR. Additional studies are needed to clarify optimal management and outcomes for NOAF and PEAF in critically ill patients.