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Publications

Journal Article Epublish

PubMed: 42894798 DOI: 10.1016/j.aicoj.2026.100159

Guidelines for the management of atrial fibrillation in adult patients admitted to an intensive care unit.

Ann Intensive Care 16:100159

Authors: Vincent Labbé, Nadia Aissaoui, Pierre Asfar, François Bagate, Simon Bourcier, Stephane Ederhy, Julie Helms, Sami Hraiech, Jérémie Joffre, Adrien Joseph, Khaldoun Kuteifan, Armand Mekontso Dessap, Sebastien Preau, Louise-Marie Jandeaux

Affiliations

  • Department of Intensive Care, Hôpital Universitaire Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium. Université Paris-Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France.
  • Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Université Paris Cité, Paris, France.
  • Médecine Intensive Réanimation et Médecine Hyperbare, CHU Angers, Angers, France.
  • Université Paris-Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France. Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, Assistance Publique des Hopitaux de Paris, Créteil, France.
  • Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Île-de-France, Melun, France.
  • Department of Pharmacology, Sorbonne Université, INSERM CIC-2503, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
  • Medicine Faculty, Medical Intensive Care Unit NHC, Strasbourg University, University Hospital Federation (FHU) TARGET, Strasbourg University Hospital, Strasbourg, France.
  • INSERM (French National Institute of Health and Medical Research, UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
  • Service de Médecine Intensive Réanimation, AP-HM, Hôpital Nord, Marseille, France.
  • Sorbonne Université, Assistance Publqiue Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Paris, France.
  • INSERM UMR_S9380 Centre de Recherche Saint-Antoine, 75012 Paris, France.
  • Médecine Intensive Réanimation, Assistance Publique des Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France.
  • Service de Réanimation Médicale GHRMSA, 68100, Mulhouse, France.
  • Université Paris-Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France.
  • Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, Assistance Publique des Hopitaux de Paris, Créteil, France.
  • Division of Intensive Care, Hôpital Roger Salengro, Centre Hospitalier Universitaire Lille, 59000, Lille, France.

Abstract

Most existing recommendations for atrial fibrillation are derived from cardiology settings. However, atrial fibrillation is also highly prevalent among patients admitted to intensive care units and is associated with adverse clinical outcomes. Therefore, its management in this specific context warrants dedicated guidance. To address this need, The French Intensive Care Society has developed formalized expert recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Twenty-four questions addressing the management of atrial fibrillation were evaluated in adult patients admitted to intensive care units. Of these, twenty-one focused specifically on new-onset atrial fibrillation, one addressed pre-existing atrial fibrillation, and two were applicable to both conditions. The assessment encompassed the role of transthoracic and transesophageal echocardiography, the management of potentially reversible triggers (optimization of fluid status, magnesium supplementation, serum potassium targets, and screening for thyroid dysfunction…), strategies for mitigating hemodynamic risk (indications and modalities for rhythm and rate control), and the management of thrombotic risk (indications, regimens, and duration of therapeutic anticoagulation). Eighteen recommendations were formulated, all of which achieved strong agreement among the expert panel. Only two recommendations were supported by a low level of evidence (GRADE 2+), whereas the remaining sixteen relied on evidence that could not be classified within the GRADE framework and were therefore issued as expert opinions. For six additional aspects of atrial fibrillation management, the experts concluded that the available evidence was insufficient to support the formulation of a reliable recommendation.

MeSH

Atrial Fibrillation, Intensive Care Units