Results from a systemic literature review published in BMJ Open reveal significant variation in managing new-onset atrial fibrillation (NOAF) in critically ill patients.
The systematic review included 16 studies reporting outcomes of a single intervention, of which two were randomised controlled trials, and three of patients with sepsis managed in intensive care. The primary outcome of interest was efficacy in achieving rhythm or rate control and secondary outcomes of mortality, stroke, bleeding and adverse events. Treatments included amiodarone (10 studies), beta-blockers (8), calcium channel blockers (6), and magnesium (3).
Across studies amiodarone, beta-blockers, calcium channel blockers, and magnesium achieved similar rates of rhythm control; amiodarone varied from 30 per cent to 95.2 per cent, beta-blockers from 31.8 to 92.3 per cent, calcium channel blockers from 30 to 87.1 per cent, and magnesium from 55.2 to 77.8 per cent. Rate control was inconsistently reported.
Only one study was sufficiently powered to consider mortality, which reported a reduction associated with beta-blockers when compared with amiodarone and digoxin between patients with NOAF and sepsis. Adverse effects of treatment were rarely reported.
The lack of randomised controlled trials and lack of standardised outcomes guiding practice prevented conclusive results. Further trials comparing all four treatments are recommended.