Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo 105-8471 Japan.
J Intensive Care. 2015 Apr 23;3(1):19. doi: 10.1186/s40560-015-0085-4. eCollection 2015.
Atrial fibrillation (AF) is a common arrhythmia in the ICU. The aim of this review is to summarize relevant information on new-onset AF in non-cardiac critical illness with respect to epidemiology, prevention, and treatment.
We conducted a PubMed search in June 2014 and included studies describing the epidemiology, prevention, and treatment of new-onset AF and atrial flutter during ICU stay in non-cardiac adult patients. Selected studies were divided into the three categories according to the extracted information. The methodological quality of selected studies was described according to the Grading of Recommendations Assessment, Development and Evaluation system.
We identified 1,132 citations, and after full-text-level selection, we included 10 studies on etiology/outcome and five studies on treatment. There was no study related to prevention. Overall quality of evidence was mostly low or very low due to their observational study designs, small sample sizes, flawed diagnosis of new-onset AF, and the absence of mortality evaluation. The incidence of new-onset AF varied from 4.5% to 15.0%, excluding exceptional cases (e.g., septic shock). Severity scores of patients with new-onset AF were higher than those without new-onset AF in eight studies, in four of which the difference was statistically significant. Five studies reported risk factors for new-onset AF, all of which used multivariate analyses to extract risk factors. Multiple risk factors are reported, e.g., advanced age, the white race, severity scores, organ failures, and sepsis. Hospital mortality in new-onset AF patients was higher than that of patients without AF in all studies, four of which found statistical significance. Among the five studies on treatment, only one study was randomized controlled, and various interventions were studied.
New-onset AF occurred in 5%-15% of the non-cardiac critically ill patients. Patients with new-onset AF had poor outcomes compared with those without AF. Despite the high incidence of new-onset AF in the general ICU population, currently available information for AF, especially for management (prevention, treatment, and anticoagulation), is quite limited. Further research is needed to improve our understanding of new-onset AF in critically ill patients.
心房颤动（AF）是 ICU 中常见的心律失常。本综述的目的是总结非心脏危重病中新发 AF 的相关信息，包括流行病学、预防和治疗。
我们于 2014 年 6 月进行了 PubMed 检索，并纳入了描述非心脏成年患者 ICU 期间新发 AF 和房扑的流行病学、预防和治疗的研究。根据提取的信息，将选定的研究分为三类。根据推荐评估、制定和评估系统（Grading of Recommendations Assessment, Development and Evaluation system）描述选定研究的方法学质量。
我们确定了 1132 条引文，经过全文筛选，纳入了 10 项关于病因/结局的研究和 5 项关于治疗的研究。没有关于预防的研究。由于观察性研究设计、样本量小、新发 AF 诊断有误以及缺乏死亡率评估，整体证据质量大多为低或极低。新发 AF 的发生率在 4.5%至 15.0%之间，不包括特殊病例（如感染性休克）。八项研究中，新发 AF 患者的严重程度评分高于无新发 AF 患者，其中四项研究的差异具有统计学意义。五项研究报告了新发 AF 的危险因素，均采用多变量分析提取危险因素。报告了多种危险因素，例如高龄、白种人、严重程度评分、器官衰竭和败血症。所有研究均发现新发 AF 患者的住院死亡率高于无 AF 患者，其中四项研究具有统计学意义。五项关于治疗的研究中，仅有一项为随机对照研究，研究了各种干预措施。
新发 AF 发生于 5%-15%的非心脏危重病患者中。与无 AF 患者相比，新发 AF 患者的预后较差。尽管一般 ICU 人群中新发 AF 的发生率较高，但目前关于 AF 的信息，特别是管理（预防、治疗和抗凝）方面的信息非常有限。需要进一步研究以提高我们对危重病患者新发 AF 的认识。
