Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study

Takuo Yoshida; Shigehiko Uchino; Yusuke Sasabuchi; Michihito Kyo; Takashi Igarashi; Haruka Inoue; AFTER-ICU Study Group

doi:10.1016/j.ijcha.2021.100742

Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study

Int J Cardiol Heart Vasc. 2021 Mar 1:33:100742. doi: 10.1016/j.ijcha.2021.100742. eCollection 2021 Apr.

Authors

Takuo Yoshida¹, Shigehiko Uchino¹, Yusuke Sasabuchi², Michihito Kyo³, Takashi Igarashi⁴, Haruka Inoue⁵; AFTER-ICU Study Group

Affiliations

¹ Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.
² Data Science Center, Jichi Medical University, Tochigi, Japan.
³ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁴ Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan.
⁵ Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Abstract

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.

Keywords: Critical illness; New-onset atrial fibrillation; Rhythm-control therapy: sinus rhythm restoration.