Treatments of new‐onset atrial fibrillation in critically ill patients: a systematic review with meta‐analysis

• Published in: Acta anaesthesiologica Scandinavica 2022-04, Vol.66 (4), p.432-446
• Main Authors: Wetterslev, Mik, Karlsen, Anders Peder Højer, Granholm, Anders, Haase, Nicolai, Hassager, Christian, Møller, Morten Hylander, Perner, Anders
• Format: Article
• Language: English
• Subjects: Adverse events; Atrial Fibrillation - drug therapy; Bias; Cardiac arrhythmia; Clinical trials; Critical Illness - therapy; Drug therapy; Evaluation; Fibrillation; Humans; Illnesses; Meta-analysis; Mortality; Patients; Pharmacology; Placebos; Quality of Life; Randomized Controlled Trials as Topic; Sequential analysis; Systematic review; Treatment Outcome
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.14032

Background New‐onset atrial fibrillation (NOAF) is common in hospitalised patients with critical illness and associated with worse outcomes. Several interventions are available in the management of NOAF, but the overall effectiveness and safety of these interventions compared with placebo or no treatment are unknown. Methods We conducted a systematic review with meta‐analysis and trial sequential analysis (TSA) of randomised clinical trials (RCT) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses, the Cochrane Collaboration, and Grading of Recommendations Assessment, Development and Evaluation statements. We searched RCTs assessing any pharmacological and non‐pharmacological treatment compared with placebo or no treatment in critically ill hospitalised patients with NOAF. The primary outcomes were all‐cause mortality, adverse events, and health‐related quality of life. Results We included 16 trials (n = 1891) evaluating seven interventions. All trials were adjudicated ‘some concerns’ or ‘high risk’ of bias. The evidence is very uncertain for mortality (RR 0.53, 95% CI 0.03–8.30), adverse events (RR 1.28, 95% CI 0.85–1.92), and treatment efficacy i.e. rhythm control (RR 1.54, 95% CI 1.20–1.97; TSA‐adjusted CI 0.56–4.53) between pharmacological treatment and placebo/no treatment (very low certainty evidence). There were no data for health‐related quality of life or most of our secondary outcomes. Conclusions The existing data are insufficient to firmly conclude on effects of any intervention against NOAF on any outcome in hospitalised patients with critical illness. Randomised trials of the most frequently used interventions against NOAF are warranted in these patients.