New-Onset Atrial Fibrillation and Treatment Strategies: Retrospective Analysis of AmsterdamUMCdb

Introduction: NOAF is most common rhythm disorders in ICU and there is a lack of optimal treatment strategy in ICU population. We examined the AmsterdamUMCdb critical care database for the incidence, risk factors and different treatment strategies adopted and their association with recurrence of AF and mortality.


Methods: Retrospective analysis of AmsterdamUMCdb was done and NOAF was defined as first occurrence of AF after stable Sinus rhythm on admission. Vital signs, use of noradrenaline, mechanical ventilation and laboratory values preceding NOAF, and after the NOAF were retrieved. Rhythm conversion attempts, either by direct current cardioversion or potentially with amiodarone, were captured. Comparison between variables was performed by Chi-square test, Kruskal Wallis test or log-rank test where appropriate. Multiple imputation of missing variables was used where appropriate for propensity adjusted analysis.


Results: Out of 23,106 of ICU admissions 808 admissions (3.5% of all screened) developed NOAF . Different treatment approaches were noted including rhythm control with DCCV or amiodarone and others including observation only, beta blockers, calcium channel blockers. Patients receiving rhythm control during NOAF were more likely to be mechanically ventilated, had higher maximum HR, lower minimum SBP, lower minimum SpO2 and lower maximum respiratory rate when compared to patients not receiving rhythm control therapy. Between 20% to 30% of those receiving one form of rhythm conversion strategy crossed over to the other kind of rhythm treatment. For those receiving DCCV (n=127) and amiodarone (n=339) as the initial rhythm treatment, the successful cardioversion rates were 68.5% and 92.6% respectively (p < 0.001). Among the 342 patients who received other forms of rhythm control therapy for NOAF, 310 (90.6%) reverted to SR.


Conclusions: We noted different treatment approaches ranging from rhythm conversion with amiodarone or DCCV through using other agents for rate control to observation only. Importantly, DCCV was associated with the lowest conversion rate, with medical approaches and observation only leading to similarly successful results. Our observations emphasize the need for further prospective studies on the optimal treatment strategy for NOAF in ICU to improve patient outcomes.