Atrial fibrillation (AF) is the most common arrhythmia experienced by critically ill patients. It has been associated with adverse short-and long-term outcomes, including an increased risk of thromboembolic events, heart failure, and death. Due to complex and multifactorial pathophysiology, a heterogenous patient population, and a lack of clinical tools for risk stratification validated in this population, AF in critical illness is challenging to predict, prevent, and manage. Personalized management strategies that consider patient factors such as underlying cardiac structure and function, potentially reversible arrhythmogenic triggers, and risk for complications of AF are needed. Furthermore, evaluation of the effects of these interventions on long-term outcomes is warranted. Critical illness survivors who have had AF represent a unique population who require systematic follow-up after discharge. However, the frequency, type, and intensity of follow-up is unknown. This state-of-the-art review aims to summarize the evidence, contextualize the current guidelines within the setting of critical illness, and highlight gaps in knowledge and research opportunities to further our understanding of this arrhythmia and improve patient outcomes.

Cardiology Department Royal Brisbane and Women's Hospital Brisbane QLD Australia

Department of Clinical Neurosciences University of Oxford Nuffield Oxford UK

Department of Critical Care Medicine Queen's University Kingston Canada

Department of Critical Care Medicine Sunnybrook Health Sciences Centre Bayview Avenue Toronto Canada

Department of Epidemiology School of Public Health Boston University Boston USA

Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark

Department of Medicine Cardiovascular Medicine Section Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine Boston USA

Division of Health Systems Science Department of Medicine University of Massachusetts Chan Medical School Worcester USA

Faculty of Health and Life Sciences Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK

Faculty of Medicine Department of Anesthesiology and Intensive Care Charles University Prague Czechia

Faculty of Medicine University of Queensland Brisbane QLD Australia

Institute of Inflammation and Ageing University of Birmingham Birmingham UK

JohnMoores University and Liverpool Heart and Chest Hospital Liverpool UK

King's College London Guy's and St Thomas' Hospital London London UK

Liverpool Centre for Cardiovascular Science University of Liverpool Liverpool UK

Management and Evaluation Institute for Health Policy University of Toronto Toronto Canada

Michael G DeGroote School of Medicine McMaster University Hamilton Canada

Temerty Faculty of Medicine Department of Anesthesiology and Pain Medicine University of Toronto Toronto Canada

The George Institute for Global Health Sydney Australia

The Ottawa Hospital Research Institute Ottawa Canada

University Hospitals of Birmingham NHS Foundation Trust Queen Elizabeth Hospital Birmingham UK

University of Sydney Royal North Shore Hospital Sydney Australia

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