Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study

Mik Wetterslev*, Morten Hylander Møller, Anders Granholm, Christian Hassager, Nicolai Haase, Theis Lange, Sheila N Myatra, Johanna Hästbacka, Yaseen M Arabi, Jiawei Shen, Maria Cronhjort, Elin Lindqvist, Anders Aneman, Paul J Young, Wojciech Szczeklik, Martin Siegemund, Thijs Koster, Tayyba Naz Aslam, Morten H Bestle, Mia S GirkovKushal Kalvit, Rakesh Mohanty, Joanne Mascarenhas, Manoranjan Pattnaik, Sara Vergis, Sai Praveen Haranath, Mehul Shah, Ziyokov Joshi, Erika Wilkman, Matti Reinikainen, Pasi Lehto, Ville Jalkanen, Anni Pulkkinen, Youzhong An, Guoxing Wang, Lei Huang, Bin Huang, Wei Liu, Hengbo Gao, Lin Dou, Shuangling Li, Wanchun Yang, Emily Tegnell, Agnes Knight, Miroslaw Czuczwar, Tomasz Czarnik, Anders Perner, and the AFIB-ICU Collaborators, Frederik Bestle (Member of study group), Anne Sofie Andreasen (Member of study group), Klaus Tjelle Kristiansen (Member of study group), Thomas Mohr (Member of study group), Peter Hasse Møller-Sørensen (Member of study group), Kirsten Møller (Member of study group)

*Corresponding author for this work


OBJECTIVES: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF.

DESIGN: Multicenter, prospective, inception cohort study.

SETTING: Forty-four ICUs in 12 countries in four geographical regions.

SUBJECTS: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021.


MEASUREMENTS AND MAIN RESULTS: We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99).

CONCLUSIONS: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.

Original languageEnglish
JournalCritical Care Medicine
Issue number9
Pages (from-to)1124-1137
Number of pages14
Publication statusPublished - 1 Sep 2023


  • Adult
  • Atrial Fibrillation/epidemiology
  • Cohort Studies
  • Humans
  • Incidence
  • Intensive Care Units
  • Prospective Studies
  • Risk Factors


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