Among critically ill patients with sustained new-onset atrial fibrillation (AF), rhythm-control therapy was found to be associated with sinus rhythm (SR) restoration, according to the findings of a study recently published in the IJC Heart & Vasculature journal.

This post-hoc analysis of the AFTER-ICU study, a prospective observational study conducted in Japan, aimed to assess the association between rhythm-control therapy and SR restoration in new-onset AF patients in the intensive care unit (ICU). The sub-analysis included 423 new-onset AF patients who had been admitted to 1 of the 32 included Japan ICUs between April 1, 2017, and March 31, 2018. The analysis compared patients who received rhythm-control therapy for the treatment of new-onset AF to those who did not. Additionally, Cox proportional hazards regression analysis was utilized to conduct a multivariable analysis, which included rhythm-control therapy as a time-varying covariate for the restoration of SR.

Of the total patients enrolled in the study, 42% (n=178) received rhythm-control therapy. Of those patients, 31% (n=131) underwent therapy within 6 hours after the onset of AF. The most frequently used rhythm-control agent was magnesium sulfate.

“The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval, 1.16–1.85),” the authors reported. They added that the rhythm-control group was found to have a numerically higher rate of hospital mortality compared to the non-rhythm-control group (31% vs 23%, respectively; P =.09). The association between rhythm-control therapy and a poorer prognosis may potentially be caused by selection bias.

“Because patients treated with rhythm-control in observational studies may have poor outcomes due to selection bias (ie, patients with hemodynamic instability tend to get the treatment), further interventional studies for rhythm-control therapy are strongly warranted to avoid this confounder,” the authors concluded.


Yoshida T, Uchino S, Sasabuchi Y, Kyo M, Igarashi T, Inoue H. Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study. Int J Cardiol Heart Vasc. 2021. doi: