Abstract
New-onset of atrial fibrillation (NOAF) in critically ill patients is the most common acute cardiac dysrhythmia, but evidence-based data regarding treatment strategies are scarce. In this retrospective monocentric study, we compared effectiveness of amiodarone versus digitalis for heart rate control in critically ill patients with new-onset of atrial fibrillation. We identified a total of 209 patients for the main analysis. Amiodarone as compared to digitalis was associated with a clinically relevant faster time to heart rate control < 110 bpm (2 h (IQR: 1 h to 6 h) versus 4 h (2 h to 12 h); p = 0.003) and longer durations of sinus rhythm during the first 24 h of treatment (6 h (IQR: 6 h to 22 h) versus 0 h (IQR: 0 h to 16 h); p < 0.001). However, more bradycardic episodes occurred in association with amiodarone than with digitalis (7.7% versus 3.4%; p = 0.019). Use of amiodarone was associated with an increase of noradrenalin infusion rate compared to digitalis (23.9% versus 12.0%; p = 0.019). Within the tertile of patients with the highest CRP measurements, amiodarone treated patients presented with a higher decrease in heart rate than digoxin treated patients. Clinical trials comparing different NOAF treatment strategies are much needed and should report on concomitant sympathetic activity and inflammatory status.
Highlights
New-onset of atrial fibrillation (NOAF) in critically ill patients is the most common acute cardiac dysrhythmia, but evidence-based data regarding treatment strategies are scarce
All 8611 admissions to the ICU between January 2015 and July 2020 were screened for this study (Fig. 1). 1177 (13.5%) patients were identified with a documented medication of intravenous amiodarone or digitalis and underwent individual patient chart data review. 412 (4.8%) patients were identified with new-onset of atrial fibrillation
Patients receiving amiodarone for new-onset of atrial fibrillation presented with a higher illness severity as compared to patients receiving digitalis (SAPS-II at admission 48 versus 42, p = 0.012)
Summary
New-onset of atrial fibrillation (NOAF) in critically ill patients is the most common acute cardiac dysrhythmia, but evidence-based data regarding treatment strategies are scarce. In this retrospective monocentric study, we compared effectiveness of amiodarone versus digitalis for heart rate control in critically ill patients with new-onset of atrial fibrillation. Very recent retrospective data suggest that amiodarone might be preferable for undifferentiated ICU patients with NOAF, but this conclusion was limited to a small patient sample size[9] We conducted this retrospective study to assess the effectiveness of digitalis compared with amiodarone in NOAF in the intensive care unit for heart rate control
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