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Commentary |

Optimizing Atrial Fibrillation ManagementOptimizing Atrial Fibrillation Management: From ICU and Beyond

Allan J. Walkey, MD; D. Kyle Hogarth, MD, FCCP; Gregory Y. H. Lip, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Walkey), The Pulmonary Center, Boston University School of Medicine, Boston, MA; Section of Pulmonary and Critical Care Medicine (Dr Hogarth), Department of Medicine, University of Chicago Medicine, Chicago, IL; Centre for Cardiovascular Sciences (Dr Lip), University of Birmingham, Birmingham, England; and Aalborg Thrombosis Research Unit (Dr Lip), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

CORRESPONDENCE TO: Allan J. Walkey, MD, Boston University School of Medicine, 72 E Concord St, R-304, Boston, MA 02118; e-mail: alwalkey@bu.edu


FUNDING/SUPPORT: This work was supported by the National Institutes of Health [K01HL116768 to Dr Walkey].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):859-864. doi:10.1378/chest.15-0358
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Atrial fibrillation (AF) that newly occurs during critical illness presents challenges for both short- and long-term management. During critical illness, patients with new-onset AF are clinically evaluated for hemodynamic instability owing to the arrhythmia as well as for potentially reversible arrhythmia triggers. Hemodynamically significant AF that persists during critical illness may be treated with heart rate or rhythm control strategies. Recent evidence suggests that patients in whom AF develops during acute illness (eg, sepsis, postoperatively) have high long-term risks for AF recurrence and for AF-associated complications, such as stroke, heart failure, and death. Therefore, we suggest increased efforts to improve communication of AF events between inpatient and outpatient providers and to reassess patients who had experienced new-onset AF during critical illness after they transition to the post-ICU setting. We describe various strategies for the assessment and long-term management of patients with new-onset AF during critical illness.

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