Incidence and Outcome of Newly Diagnosed Atrial Fibrillation in Medical ICU Patients: An Observational Descriptive Study

Introduction: Cardiac arrhythmias are a common occurrence among critically ill patients in the intensive care unit (ICU) and can have significant implications for their health outcomes. Among these arrhythmias, supraventricular cardiac arrhythmic tachycardia, particularly atrial fibrillation, is increasing in incidence and manifests across a range of medical and surgical settings [1]. In medical patients, the incidence ranges from 1% to 46%. In patients with sepsis, the incidence of acute AF varies with the severity of sepsis, with an incidence of 8% to 10% in sepsis, 6% to 22% in severe sepsis, and 23% to 44% in septic shock [2-6]. The development of cardiac arrhythmias in critically ill patients poses a substantial risk to both morbidity and mortality [3–6].

Aim: To study the incidence and outcome of new-onset atrial fibrillation in medical ICU patients.

Materials and Methods: New-onset atrial fibrillation was noted in patients who were admitted to the medical ICU with normal ECG and later on developed atrial fibrillation.

Results: A total of 420 patients were observed for 24 hours with continuous ECG monitoring. Among 420 patients, 68 developed new-onset arrhythmias. Out of 420 patients, 21 developed atrial fibrillation (5%). AF is more common in the population with pre-existing cardiac illness (76.1%). Among non-cardiac illnesses, pneumonia was the leading cause,12(57.1%) patients expired and 9 (42.8%) patients were discharged. Out of the discharged patients 5 patients still had persisting AF (45.4%).

Conclusion: It has been observed that there is an increased incidence of atrial fibrillation in critically ill patients. AF is associated with increased mortality and morbidity. Early detection and treatment can change disease outcomes. Hence, 24-hour ECG monitoring should be done in critically ill patients. The majority of individuals who survive acute illness and develop new-onset atrial fibrillation (AF) experience AF symptoms after being discharged from the hospital and may face higher long-term risks of heart failure, ischemic stroke, and mortality. There are no evidence-based guidelines or expert consensus documents on the management of NOAF. To address these uncertainties, well-designed multicentred, prospective randomized trials are necessary.