Work

Sepsis-associated atrial fibrillation: Current insights and research priorities for standardized care

Year: 2026

Type: review

Abstract: Sepsis-associated atrial fibrillation (SAAF) is a common but serious complication in critically ill patients that is characterized by new-onset atrial fibrillation (AF) during sepsis. This secondary type of arrhythmia typically resolves with sepsis treatment but is associated with substantial morbidity and mortality, including prolonged hospital stays, high recurrence rates of AF, and increased risks of heart failure, stroke, and short-term and long-term mortality. In contrast to primary AF, no standardized guidelines have been established for SAAF. To support the development of evidence-based protocols, we conducted a comprehensive review to synthesize the current knowledge of SAAF. Here, we highlight the definition, incidence, and risk factors of SAAF and distinguish it from primary AF and other types of secondary AF, including postoperative and post-myocardial infarction AF. We also describe the multifactorial pathophysiologic mechanisms of SAAF involving systemic inflammation, cytokine release, autonomic dysfunction, myocardial injury, and hemodynamic stress. Key outcomes of patients with SAAF and other types of secondary AF are compared, including in-hospital mortality, long-term AF recurrence, and stroke risk. Furthermore, we discuss various management strategies for SAAF, including methods of rhythm control and rate control in patients with SAAF. Anticoagulation recommendations and challenges for patients with SAAF are highlighted, particularly with respect to thrombotic risk, bleeding risk, and anticoagulation use. We propose a process for anticoagulation decisions in SAAF, which are challenging due to the dynamic interplay between sepsis-induced coagulopathy and thromboembolic risk. Finally, we provide a summary of future research priorities to support large-scale, multicenter trials to define evidence-based protocols that are critical for improving outcomes in this high-risk population.

Source: Journal of Intensive Medicine

DOI: 10.1016/j.jointm.2026.06.006

Authors: Alison C. Leslie, Omar Abdelgawwad, Sameh Hozayen

Institutions: Hospital of the University of Pennsylvania, Mansoura University, Mansoura University Hospital, Mayo Clinic, Mayo Clinic Hospital

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,100