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. 2021 Dec:67:103114.
doi: 10.1016/j.iccn.2021.103114. Epub 2021 Aug 6.

Triggers for new-onset atrial fibrillation in critically ill patients

Jonathan P Bedford  1 , Jody Ede  2 , Peter J Watkinson  3
Affiliations

Triggers for new-onset atrial fibrillation in critically ill patients

Jonathan P Bedford et al. Intensive Crit Care Nurs. 2021 Dec.
No abstract available

Keywords: Arrhythmia; Atrial fibrillation; Critical illness; Intensive care; Risk factors.

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Conflict of interest statement

Conflicts of Interest

Figures

Figure 1
Figure 1. Potential mechanisms for new-onset atrial fibrillation during ICU admission.
An arrhythmogenic substrate (a structurally and electrically remodelled myocardium) can develop prior to acute illness or surgery due to ageing and comorbidities. Further accelerated remodelling can then occur during critical illness or in the perioperative period. Electrical remodelling (changes in ion handling and connexin expression) occurs alongside structural remodelling (atrial stretch and fibrosis). Factors such as high sympathetic drive, fluid overload and systemic inflammation promote remodelling such that on arrival to the ICU, there is an elevated predisposition to new-onset AF (NOAF). Arrhythmogenic potential will depend on the combined effects of comorbidities and acuteillness-related factors on the myocardium and will vary considerably from patient to patient. Each factor is not uniquely required, but adds to an accumulated risk. Exposure to triggering events may then initiate AF through multiple mechanisms, which is then sustained due to underlying remodelled tissue. CCF = congestive cardiac failure; COPD = Chronic obstructive pulmonary disease; AF = atrial fibrillation.
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