New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality

Abstract

Background The development of new-onset atrial fibrillation in sepsis has been associated with adverse outcomes. Methods A systematic literature search was conducted to retrieve articles that investigated the association of new-onset atrial fibrillation in patients diagnosed with sepsis. The primary outcome of interest was the pooled risk ratio (RR) of in-hospital mortality in patients with new-onset atrial fibrillation and sepsis. Results Six studies included 3100 patients with new-onset atrial fibrillation in sepsis and 36,900 patients without newonset atrial fibrillation in sepsis. The pooled RR for in-hospital mortality was 1.45 (95% CI 1.32–1.60, p < 0.00001, I2 = 24%). New-onset atrial fibrillation was also associated with increased ICU mortality, ICU and in-hospital length of stay and stroke. New-onset atrial fibrillation occurred more in the elderly, those with a prior history of cardiovascularand respiratory disease, and those with increased severity of illness. Conclusion Prospective randomised trials are needed to clarify the significance of new-onset atrial fibrillation in sepsis, optimal treatment strategies for these patients, and the benefit of systemic anticoagulation. Physicians should be aware that new-onset atrial fibrillation in sepsis is not merely an observed temporary arrhythmia but a marker of poor prognosis and should be managed accordingly.