The management of new-onset atrial fibrillation in critical illness: an update on current therapeutic options.

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Opinion in Cardiology Pub Date : 2025-01-01 Epub Date: 2024-10-09 DOI:10.1097/HCO.0000000000001186
Zhe Wang, Jiang Li, Yihong Sun
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引用次数: 0

Abstract

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

危重病人新发心房颤动的管理:当前治疗方案的最新进展。
审查目的:新发心房颤动(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有关。目前,治疗这类患者的 NOAF 的证据非常有限:最近的研究结果:已进行了大量的荟萃分析,以评估急性期心房颤动治疗的效果,包括心率或心律控制策略、抗凝和重症监护干预。使用β受体阻滞剂控制心率似乎对重症患者更有益。然而,由于出血风险,抗凝治疗的优势仍不明确,部分原因是在危重病的复杂情况下缺乏证据。大约三分之一的一过性心房颤动患者会在一年内复发。因此,应考虑对高危患者进行入院后警惕性随访和监测,以发现心房颤动复发。长期抗凝策略应根据患者的个体情况量身定制,权衡血栓栓塞的风险:预测心房颤动复发的因素包括年龄、心房颤动负担和心房大小。关于危重病人的 NOAF 还存在很大的知识差距,因此需要进一步研究,尤其是随机临床试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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