Abstract
Background: New-onset atrial fibrillation (NOAF) commonly occurs amongst critically unwell individuals and represents a management challenge. However, limited data exist regarding the role of structural cardiac abnormalities in NOAF. Methods: All patients in a tertiary general ICU developing AF between Dec 2015 to Dec 2016 were identified by an automated alert system. Patients with a previous history of AF were excluded. Data on left atrial size (left atrial volume index, LAVI) and ejection fraction (LVEF) were collected on patients who underwent an echocardiogram during their admission. Results: 111 patients developed NOAF during the study period, and 84 (75.7%) underwent echocardiography. The distribution of left atrial (LA) size and ejection fraction is shown in Figures 1 and 2 below. 26 patients (31%) had a normal LAVI, 63 patients (75%) had an LVEF > 50%, and 21 patients (25%) had both normal LA size and LVEF. Conclusions: A substantial proportion of NOAF in the ICU population occurs in the presence of normal LA size and LV systolic function. These findings highlight the significance of extracardiac factors in driving NOAF in critically unwell individuals.
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