Sepsis, new-onset AF and restored sinus rhythm – prognostic impact

prognostic impact of restored sinus rhythm - sepsis - new-onset AF


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


  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


  1. applicability to ED management already limited given exclusion criteria of ICU patients staying < 3 days
  2. higher mortality may simply reflect higher sepsisĀ 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?

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