Sepsis-associated atrial fibrillation: Current insights and research priorities for standardized care.
- 1Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
- 2Division of General Internal Medicine, Mansoura University Hospital, Mansoura 35516, Egypt.
- 3Division of Hospital Internal Medicine, Mayo Clinic, Phoenix 85054, USA.
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.
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BibTeX
@article{leslie2026sepsisassociated,
title = {{Sepsis-associated atrial fibrillation: Current insights and research priorities for standardized care.}},
author = {Alison C Leslie and Omar Abdelgawwad and Sameh Hozayen},
journal = {Journal of intensive medicine},
year = {2026},
month = jul,
doi = {10.1016/j.jointm.2026.06.006},
url = {https://europepmc.org/article/MED/42997017},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Sepsis-associated atrial fibrillation: Current insights and research priorities for standardized care.
AU - Alison C Leslie
AU - Omar Abdelgawwad
AU - Sameh Hozayen
PY - 2026
DA - 2026/07/06
JO - Journal of intensive medicine
DO - 10.1016/j.jointm.2026.06.006
UR - https://europepmc.org/article/MED/42997017
AB - 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.
SN - 2097-0250
SN - 2667-100X
ER -