Anest. intenziv. Med. 2026;37(1):28-35 | DOI: 10.36290/aim.2026.011

Left atrium and atrial fibrillation in critically ill patients: from echocardiography to therapyPřehledový článek

Tencer T.^{1, 2}, Waldauf P.³, Balik M.⁴

¹ Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, Motol University Hospital and Second Faculty of Medicine, Charles University, Prague

² Third Faculty of Medicine, Charles University, Prague

³ Department of Anaesthesiology and Resuscitation, Kralovske Vinohrady University Hospital, Third Faculty of Medicine, Charles University, Prague

⁴ Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague

New­‑onset atrial fibrillation is common in critically ill patients with septic shock and worsens haemodynamics through loss of atrial contraction, shortening of diastolic filling time, decrease in cardiac output, and elevation of filling pressures. In this context, atrial fibrillation is associated with prolonged hospitalisation, a higher risk of ischaemic stroke, and increased mortality. The pathogenesis is multifactorial, combining patient­‑specific predispositions and triggers associated with critical illness. These include excessive catecholamine release, electrolyte imbalances, autonomic nervous system dysregulation, systemic inflammation, and changes in preload and afterload. Together, these factors enhance atrial arrhythmogenicity and predispose to the development of new­‑onset atrial fibrillation. Bedside echocardiography enables personalised diagnosis, treatment, and prevention. Parameters focused on the left atrium aid in the risk stratification of atrial fibrillation, prediction of sinus rhythm maintenance, and selection of an appropriate management strategy (rhythm control vs. rate control). Therefore, a comprehensive and individualised assessment of the left atrium, along with evaluation of diastolic and systolic function of both ventricles, should be an integral part of arrhythmia management in patients with septic shock. This review also provides a practical bedside algorithm to guide phenotype­‑based management.

Klíčová slova: new­‑onset atrial fibrillation, sepsis, septic shock, echocardiography, left atrium, anticoagulation.

Vloženo: 23. prosinec 2025; Revidováno: 28. březen 2026; Přijato: 28. březen 2026; Zveřejněno: 9. duben 2026  Zobrazit citaci