Key points:

1. single centre, retrospective cohort study
2. 503 patients with sepsis – (263 without new onset AF; 240 with new onset AF)
3. sinus rhythm restored in 165 of 240; mix of amiodarone / beta-blockers / calcium channel blocker / digoxin / DCR
4. mortality of new onset AF group highest (61.3%) vs new AF with restored sinus rhythm (26.1%) vs no new AF (17.5%)
5. hypothesis that restoring sinus rhythm may improve outcomes

Issues:

1. excluded patients with ICU stay < 3 days and those > 90 yrs old
2. new onset AF group were older, higher prevalence of hypertension, CCF and coronary artery disease
3. new onset AF group had higher Sepsis-related Organ Failure Assessment (SOFA) score (9.3 vs 7.0) and APACHE II scores (24.6 vs 21.6) to no AF group

Discussion:

1. applicability to ED management already limited given exclusion criteria of ICU patients staying < 3 days
2. higher mortality may simply reflect higher sepsis burden +/- co-morbidities
3. Unclear if intervention or sepsis management resulted in reversion to sinus
4. no single intervention tested in this study

Other thoughts?