Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey

Chung Shen Chean, Daniel McAuley, Anthony Gordon, Ingeborg Dorothea Welters, Chung Shen Chean, Daniel McAuley, Anthony Gordon, Ingeborg Dorothea Welters

Abstract

Background: New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Although evidence base and expert consensus opinion for management have been summarised in several international guidelines, no specific considerations for critically ill patients have been included. We aimed to establish current practice of management of critically ill patients with new-onset AF.

Methods: We designed a short user-friendly online questionnaire. All members of the Intensive Care Society were invited via email containing a link to the questionnaire, which comprised 21 questions. The online survey was conducted between November 2016 and December 2016.

Results: The response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) would start intervention on patients with fast new-onset AF and stable blood pressure at a heart rate between 120 and 139 beats/min. However, 34.8% of participants would treat all patients who developed new-onset fast AF. Amiodarone and beta-blockers (80.9% and 11.6% of answers) were the most commonly used anti-arrhythmics. A total of 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. A total of 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. A total of 85.4% of participants would consider taking part in a clinical trial investigating treatment of new-onset fast AF in the critically ill.

Discussion: Our results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, particularly with regard to anti-arrhythmics and anti-coagulation used. Amongst intensivists, there is a substantial interest in research for management of new-onset AF in critically ill patients.

Keywords: Anti-arrhythmics; Anti-coagulation; Arrhythmia; Atrial fibrillation; Critical care; Sepsis.

Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1. Medications used for treatment of…
Figure 1. Medications used for treatment of new-onset atrial fibrillation.
Figure 2. Case vignette to assess treatment…
Figure 2. Case vignette to assess treatment of new-onset atrial fibrillation with fast ventricular rate.
Figure 3. Electrolytes level targets in the…
Figure 3. Electrolytes level targets in the management of atrial fibrillation.
Figure 3. Electrolytes level targets in the…
Figure 3. Electrolytes level targets in the management of atrial fibrillation.
Figure 4. Rationale for choosing anti-arrhythmic treatment…
Figure 4. Rationale for choosing anti-arrhythmic treatment for new-onset AF in critically ill patients.
Other reasons given included “Effectiveness”, “Chance of cardioversion”, “Amiodarone works”.

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