SPC365

Management of New-Onset Atrial Fibrillation in the Intensive Care Unit: Where Do We Stand?

Session: SESSÃO DE POSTERS 33 - DOENÇAS CARDIOVASCULARES - MINOCA E SÍNDROME DE TAKOTSUBO
Speaker: Rita Figueiredo

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type: Cartazes
FP Number: ---
Authors: Ana Rita M. Figueiredo; Catarina Gregório; Miguel Raposo; Ana Abrantes; João Fonseca; Marta Vilela; Daniel Cazeiro; João Cravo; Diogo Ferreira; Susana M. Fernandes; Fausto J. Pinto; Doroteia Silva

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: New-onset atrial fibrillation (NOAF) is frequently observed in patients (pts) treated in an intensive care unit (ICU), yet the long-term impacts on patient outcomes remain unclear. While various management strategies are utilized, the evidence available is limited and primarily derived from non-ICU populations.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To characterize the population of pts with NOAF admitted to the ICU and evaluate the preferred management strategies.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Observational, single-center, retrospective study of pts with NOAF admitted to a multidisciplinary ICU between January 2020 and June 2022. Clinical and demographic data were collected.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Of the 3692 patients (pts) admitted in the ICU, NOAF was observed in 161 pts (4.4%) (101 males, 69.5&plusmn;11.8 years). Among these patients, 67% had hypertension, 35% diabetes, 21% obesity, 13% ischemic heart disease, and 15% a history of heart failure. 30% of pts were previously on therapy with beta-blockers (BB) and 4% on antiarrhythmics.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The main reasons for ICU admission were sepsis/septic shock (73%), trauma (10%), and cardiogenic shock (7%). During hospitalization, 79% developed cardiovascular dysfunction. The preferred first-line strategy for managing NOAF was rhythm control (85%), observation (7.5%) or rate control (7.5%). Among the subgroup managed with rhythm control, 27 pts underwent electrical cardioversion combined with amiodarone, 5 received electrical cardioversion alone, and the remaining 104 were treated with amiodarone therapy. Other antiarrhythmics were not used. There was no difference between BB and digoxin use, among frequency control strategy.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Anticoagulation was initiated in only 72 pts (39% enoxaparin, 6% unfractionated heparin). A recurrent episode of AF occurred in half of the pts during hospitalization. 33% of pts died during their ICU stay; however, AF recurrence was not a predictor of ICU mortality. No predictors of ICU mortality were identified in the NOAF cohort.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At discharge, only 45% of pts were on anticoagulation therapy. Among these, 24% were on BB, and 14% were on a combination of amiodarone and BB. During a follow-up (Fup) period of 428 days (1-1705), 47% of pts experienced AF recurrence, and 35% of pts died (13 from cardiovascular causes). 10 pts were readmitted to the hospital for cardiovascular causes (2 pts for heart failure decompensation due to AF with a high ventricular rate, and 1 patient for cardioembolic stroke).&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: In ICU pts with NOAF, rhythm control is the preferred strategy. Recurrence rates of AF remain high during ICU stay and in the Fup, despite the limited initiation of anticoagulation therapy. The acute severe illness that led to ICU admission may act as a trigger for pre-existing atrial disease, underscoring the importance of continuous monitoring and Fup of these pts. </span></span></span></p>