An International Survey of the Management of Atrial Fibrillation in Critically Unwell Patients

• Published in: Critical care explorations 2024-04, Vol.6 (4), p.e1069
• Main Authors: Johnston, Brian W, Udy, Andrew A, McAuley, Daniel F, Mogk, Martin, Welters, Ingeborg D, Sibley, Stephanie
• Format: Article
• Language: English
• Subjects: Original Clinical Report
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000001069

To evaluate the current management of new-onset atrial fibrillation and compare differences in practice regionally. Cross-sectional survey. United States, Canada, United Kingdom, Europe, Australia, and New Zealand. Critical care attending physicians/consultants and fellows. None. A total of 386 surveys were included in our analysis. Rate control was the preferred treatment approach for hemodynamically stable patients (69.1%), and amiodarone was the most used antiarrhythmic medication (70.9%). For hemodynamically unstable patients, a strategy of electrolyte supplementation and antiarrhythmic therapy was most common (54.7%). Physicians responding to the survey distributed by the Society of Critical Care Medicine were more likely to prescribe beta-blockers as a first-line antiarrhythmic medication (38.4%), use more transthoracic echocardiography than respondents from other regions (82.4%), and more likely to refer patients who survive their ICU stay for cardiology follow-up if they had new-onset atrial fibrillation (57.2%). The majority of survey respondents (83.0%) were interested in participating in future studies of atrial fibrillation in critically ill patients. Significant variation exists in the management of new-onset atrial fibrillation in critically ill patients, as well as geographic variation. Further research is necessary to inform guidelines in this population and establish if differences in practice impact long-term outcomes.