• Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi, and AFTER-ICU study group.
• Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan. Electronic address: aftericustudy@gmail.com.
• J Crit Care. 2020 Oct 1; 59: 136-142.

PurposeEpidemiological information is lacking after identification of new-onset atrial fibrillation (AF) in critically ill patients. This study aimed to describe the clinical course after the identification of new-onset AF.Materials And MethodsThis prospective cohort study enrolled adult patients with new-onset AF in 32 Japanese ICUs during 2017-2018. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions for AF, cardiac rhythm transition, adverse events and in-hospital death and stroke.ResultsWe included 423 new-onset AF patients. At the AF onset, mean arterial pressure decreased and the heart rate increased. Eighty-four patients (20%) spontaneously restored sinus rhythm and 328 patients (78%) received various pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). Anticoagulants were administered in 173 patients (40%) and 13 patients (3%) experienced bleeding complications. Twenty-four patients (6%) were still in AF at 168 h after the onset (sustained AF 4%; recurrent AF 2%). The overall hospital mortality was 26% and the incidence of in-hospital stroke was 4.5%.ConclusionsAlthough the proportion of patients with AF continued to decrease with various treatments, these patients had high risk of death. Further research to assess the management of new-onset AF in critically ill patients is warranted.Copyright © 2020 Elsevier Inc. All rights reserved.

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