Managing new-onset atrial fibrillation in critically ill patients: a systematic narrative review

Area of Science:

• Critical Care Medicine
• Cardiology
• Pharmacology

Background:

• New-onset atrial fibrillation (NOAF) is a common complication in critically ill patients.
• Management strategies for NOAF in intensive care units (ICUs) lack standardization.
• Evidence regarding the efficacy and safety of various antiarrhythmic agents in this population is limited.

Purpose of the Study:

• To review and synthesize the current evidence on the efficacy and safety of treatments for new-onset atrial fibrillation (NOAF) in critically ill adult patients.
• To identify gaps in the literature and guide future research directions.

Main Methods:

• A systematic search of MEDLINE, EMBASE, and Web of Knowledge was conducted up to March 2019.
• Included randomized controlled trials (RCTs) and observational studies reporting treatment efficacy for NOAF in critically ill patients.
• Data extraction and quality assessment were performed using the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa Scale.

Main Results:

• Sixteen studies were included, with only two RCTs, indicating generally low study quality.
• Amiodarone was the most frequently studied agent, followed by beta-blockers, calcium channel blockers, and magnesium.
• Reported rates of successful rhythm control varied widely across all studied agents, with amiodarone showing a broad range (30.0%–95.2%).
• Adverse effects were infrequently reported across the included studies.

Conclusions:

• The efficacy of amiodarone, beta-blockers, calcium channel blockers, and magnesium for rhythm control in NOAF among critically ill patients is highly variable.
• Future research should prioritize comparative studies on the efficacy and safety of amiodarone, beta-blockers, and magnesium.
• Further investigation is required to guide decisions regarding anticoagulant use in this patient population.