New-onset atrial fibrillation in septic shock patients

Abstract

New-onset atrial fibrillation (NAF) occurs in 4.5 to 11% of patients admitted to the intensive care unit (ICU) and can occur in up to 46% of patients with septic shock. The morbidity associated with NAF is well established (hemodynamic instability, stroke, increased length of stay), but data are lacking regarding the impact of new-onset AF on mortality in these patients. Guidelines for rhythm management from professional societies recommend preferentially controlling heart rate in case of hemodynamic repercussions, rather than rhythm control. In this latter case, a short-acting beta-blocker seems a valuable option (e.g. esmolol) to block sympathetic activation, which is particularly active at the acute phase of septic shock. Regardless of the strategy chosen, the risk factors for NAF should be identified and controlled, particularly water-electrolyte imbalance. Anticoagulation can be considered if the patient returns to sinus rhythm, and may depend on thrombo-embolic risk (CHA²DS²VASc) and bleeding risk scores (HAS-BLED).. The risk of stroke persists in the medium and long-term in these patients, even after a return to sinus rhythm, and requires regular follow-up to screen for silent AF.