Wang Zhe, Li Jiang, Sun Yihong
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Curr Opin Cardiol. 2025 Jan 1;40(1):31-36. doi: 10.1097/HCO.0000000000001186. Epub 2024 Oct 9.
New-onset atrial fibrillation (NOAF) is the most prevalent arrhythmia among critically ill patients, correlating with heightened morbidity and mortality rates. Current evidence for managing NOAF in this patient population is limited.
Numerous meta-analyses have been conducted to assess the efficacy of atrial fibrillation treatments in acute settings, including rate or rhythm control strategies, anticoagulation, and intensive care interventions. The employment of β-blockers for rate control appears to confer greater benefits in critically ill patients. However, the advantage of anticoagulation remains ambiguous because of bleeding risks, which is partly attributed to the scarcity of evidence in the complex context of critical illness. Approximately one-third of patients with transient atrial fibrillation face recurrence within a year. Therefore, vigilant posthospitalization follow-up and monitoring should be considered for high-risk patients to detect atrial fibrillation recurrence. Long-term anticoagulation strategies should be tailored to individual patient profiles, weighing the risks of thromboembolism.
Factors predicting atrial fibrillation recurrence include age, the burden of atrial fibrillation, and atrial size. There are significant knowledge gaps concerning NOAF in critically ill patients, highlighting the need for further research, particularly randomized clinical trials.
新发房颤（NOAF）是重症患者中最常见的心律失常，与发病率和死亡率升高相关。目前关于该患者群体中NOAF管理的证据有限。
已进行了多项荟萃分析，以评估房颤治疗在急性情况下的疗效，包括心率或节律控制策略、抗凝和重症监护干预措施。使用β受体阻滞剂进行心率控制似乎在重症患者中带来更大益处。然而，由于出血风险，抗凝的优势仍不明确，这部分归因于危重病复杂情况下证据的稀缺。约三分之一的短暂性房颤患者在一年内会复发。因此，对于高危患者应考虑进行出院后密切随访和监测，以检测房颤复发。长期抗凝策略应根据个体患者情况进行调整，权衡血栓栓塞风险。
预测房颤复发的因素包括年龄、房颤负担和心房大小。关于重症患者中的NOAF存在重大知识空白，凸显了进一步研究的必要性，尤其是随机临床试验。
