Introduction: Data regarding effective rhythm or rate management for new onset atrial fibrillation (AF) in critically ill sepsis patients managed in the medical intensive care unit (MICU) are sparse.
Hypothesis: We tried to compare the outcomes after rhythm or rate control strategy in these patients.
Methods: A total of 5,383 sepsis patients were managed in MICU of Asan Medical Center from 2007 through 2015. Among these patients, 482 experienced new-onset AF, and the medical records of them (mean 68.2 years old, 68.9% male, median CHADS2VASC score 3, median APACHEII score 24) were reviewed. After exclusion of 34 patients who underwent urgent electrical cardioversion, patients were divided into two groups (rhythm control, 43.5%; rate control group, 56.7%) according to the initial management strategy. The main outcomes of the current study were rate of mortality, thromboembolism, and sinus conversion at 28 days after AF onset.
Results: ICU interventions such as mechanical ventilator, inotropics or vasopressor, and renal replacement treatment were applied in 84.5%, 59.9%, and 26.8% of the patients at the time of AF onset. Amiodarone was predominantly used as a rhythm control measure (95.4%). After propensity matching, patients managed by rhythm control strategy showed higher sinus conversion rate compared to those with rate control strategy (39.8% vs. 19.8%, p<0.001). However, mortality rate (54.9% vs. 49.3%, p=0.529) or thromboembolic events (5.5% vs. 7.6%, p=0.635) were not different between the two groups.
Conclusions: Early rhythm control strategy could facilitate the sinus conversion. However, it did not provide additional benefits over rate control strategy in terms of hard outcomes.