Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study
Background: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhyth...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906721000300 |
| _version_ | 1819136136506769408 |
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| author | Takuo Yoshida Shigehiko Uchino Yusuke Sasabuchi Michihito Kyo Takashi Igarashi Haruka Inoue |
| author_facet | Takuo Yoshida Shigehiko Uchino Yusuke Sasabuchi Michihito Kyo Takashi Igarashi Haruka Inoue |
| author_sort | Takuo Yoshida |
| collection | DOAJ |
| description | Background: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients. Methods: This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration. Results: Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16–1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09). Conclusions: Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF. |
| first_indexed | 2024-12-22T10:30:11Z |
| format | Article |
| id | doaj.art-2c924997ac2b4dc6a1df73b6f1d895ac |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-22T10:30:11Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-2c924997ac2b4dc6a1df73b6f1d895ac2022-12-21T18:29:20ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672021-04-0133100742Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU studyTakuo Yoshida0Shigehiko Uchino1Yusuke Sasabuchi2Michihito Kyo3Takashi Igarashi4Haruka Inoue5Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan; Corresponding author.Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, JapanData Science Center, Jichi Medical University, Tochigi, JapanDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JapanDepartment of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, JapanDepartment of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanBackground: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients. Methods: This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration. Results: Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16–1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09). Conclusions: Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.http://www.sciencedirect.com/science/article/pii/S2352906721000300New-onset atrial fibrillationCritical illnessRhythm-control therapy: sinus rhythm restoration |
| spellingShingle | Takuo Yoshida Shigehiko Uchino Yusuke Sasabuchi Michihito Kyo Takashi Igarashi Haruka Inoue Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study International Journal of Cardiology: Heart & Vasculature New-onset atrial fibrillation Critical illness Rhythm-control therapy: sinus rhythm restoration |
| title | Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study |
| title_full | Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study |
| title_fullStr | Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study |
| title_full_unstemmed | Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study |
| title_short | Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study |
| title_sort | rhythm control therapy for new onset atrial fibrillation in critically ill patients a post hoc analysis from the prospective multicenter observational after icu study |
| topic | New-onset atrial fibrillation Critical illness Rhythm-control therapy: sinus rhythm restoration |
| url | http://www.sciencedirect.com/science/article/pii/S2352906721000300 |
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