PŘEHLEDOVÉ ČLÁNKY / REVIEW ARTICLES Left atrium and atrial fibrillation in critically ill patients: from echocardiography to therapy 34 | ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA / Anest intenziv Med. 2026;37(1):28-35 / www.aimjournal.cz indicated; the decision must be individualised according to the presence of atrial fibrillation recurrence, comorbidities, bleeding risk, and the patient’s overall condition. The risk of thromboembolic events is lower in patients with normal left ventricular systolic function (1.5%), whilst in patients with global left ventricular systolic dysfunction it increases to 12.6%. If an additional risk factor, such as left atrial dilatation with LA ESD > 25 mm/m², is present, the risk may further increase up to 20% [39]. Moderate to severe mitral regurgitation may reduce the risk of thrombus formation in the left atrial appendage due to increased "wash‑out" [40, 41]. Limitations of evidence and research gaps Randomised trials in the intensive care setting are scarce, and studies that guide treatment using predefined echocardiographic stratification of phenotypes are almost entirely absent; most evidence is derived from observational cohorts or from RCTs outside septic shock on non‑ICU patients, which limits the generalisability of conclusions to the broader critically ill population. Comparability is further hampered by the heterogeneity in NOAF definitions, differing monitoring methods (intermittent ECG vs. continuous recording), and inconsistent thresholds for left atrial parameters (e. g., LAVi, LAEF, AVTI). Echocardiographic indicators are highly dependent on preload, afterload, heart rate, and rhythm, and in unstable patients they fluctuate rapidly; examination should therefore be repeated with every clinically significant haemodynamic change, parameters should be averaged over multiple cycles, and findings must always be interpreted in the clinical context. Future research should target multicentre RCTs with protocolised POCUS/TTE (including core‑lab evaluation), standardised cut‑off values for left atrial parameters, and predefined clinical endpoints (rate/rhythm control, haemodynamics, AF recurrence, bleeding, mortality). Analysis of long‑term follow‑up outcomes and quality of life after intensive care discharge warrants further investigation. Conclusion Bedside echocardiography focused on left atrial parameters, interpreted in the context of diastolic and systolic function, provides rapidly accessible and clinically relevant data for guiding NOAF therapy in patients with septic shock. Left atrial dimensional and functional indicators, particularly LAVi and parameters assessed post‑cardioversion (e.g., LAEF, AVTI), can help to estimate sinus rhythm maintenance and recurrence risk, thereby individualising the decision between rhythm control and rate control. Simple, standardised POCUS/TTE protocols can facilitate decision‑making and potentially improve both short‑term and long ‑term outcomes in critically ill patients; however, their benefit requires further prospective validation in the intensive care setting. PROHLÁŠENÍ AUTORŮ: Prohlášení o použití AI: Při přípravě práce byl použit nástroj Perplexity v období 25. 03. 2025 – 28. 03. 2026. Nástroj byl použit k jazykové a stylistické revizi rukopisu v angličtině, zejména k opravě gramatických chyb a zlepšení čitelnosti textu. Prohlášení o původnosti: Potvrzujeme, že práce je původní a nebyla publikována ani není zaslána k recenznímu řízení do jiného média. Střet zájmů: Autoři nemají střet zájmů v souvislosti s tématem práce. Souhlas se zněním článku: Potvrzujeme, že všichni autoři rukopis četli, souhlasí s jeho zněním a zasláním do redakce časopisu Anesteziologie a intenzivní medicína. Podíl autorů: Konceptualizace – MB, psaní (originální návrh) – TT, PW, psaní (recenze a úpravy) – PW, MB, vedení a koordinace – PW, MB. Financování: Žádné Poděkování: Rádi bychom poděkovali kolegům MG, TZ, VŠ za jejich pomoc při přípravě obrázků do této publikace. Registrace: NA Projednání etickou komisí: NA REFERENCES 1. Clark DM, Plumb VJ, Epstein AE, Kay GN. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol. 1997;30(4):1039-45. 2. Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis. JAMA. 2011;306(20):2248-2254. 3. Klein Klouwenberg PM, Frencken JF, Kuipers S, Ong DS, Peelen LM, van Vught LA, et al. Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study. Am J Respir Crit Care Med. 2017;195(2):205-11. 4. Wetterslev M, Hylander Moller M, Granholm A, Hassager C, Haase N, Lange T, et al. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIBICU Cohort Study. Crit Care Med. 2023;51(9):1124-37. 5. Kuipers S, Klouwenberg PMK, Cremer OL. Incidence, risk factors and outcomes of newonset atrial fibrillation in patients with sepsis: a systematic review. Crit Care. 2014;18(6):688. 6. Wetterslev M, Haase N, Hassager C, Belley-Cote EP, McIntyre WF, An Y, et al. Newonset atrial fibrillation in adult critically ill patients: a scoping review. Intensive Care Med. 2019;45(7):928-38. 7. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns H, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-414. 8. Moss TJ, Calland JF, Enfield KB, Gomez-Manjarres DC, Ruminski C, DiMarco JP, et al. NewOnset Atrial Fibrillation in the Critically Ill. Crit Care Med. 2017;45(5):790-7. 9. Arrigo M, Bettex D, Rudiger A. Management of atrial fibrillation in critically ill patients. Crit Care Res Pract. 2014;2014:840615. 10. Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term Outcomes Following Development of New-Onset Atrial Fibrillation During Sepsis. Chest. 2014;146(5):1187-95. 11. Bosch NA, Cohen DM, Walkey AJ. Risk Factors for New-Onset Atrial Fibrillation in Patients With Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med. 2019;47(2):280-7. 12. Bedford JP, Ede J, Watkinson PJ. Triggers for new-onset atrial fibrillation in critically ill patients. Intensive Crit Care Nurs. 2021;67:103114. 13. Sibley S, Bedford J, Wetterslev M, Johnston B, Garside T, Kanji S, et al. Atrial fibrillation in critical illness: state of the art. Intensive Care Med. 2025;51:904-16. 14. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-66. 15. Bosch NA, Cimini J, Walkey AJ. Atrial Fibrillation in the ICU. Chest. 2018;154(6):1424-34. 16. L’Heureux M, Sternberg M, Brath L, Turlington J, Kashiouris MG. Sepsis-Induced Cardiomyopathy: a Comprehensive Review. Curr Cardiol Rep. 2020;22(5):35. 17. Nagueh SF, Sanborn DY, Oh JK, Anderson B, Billick K, Derumeaux G, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(7):537-569. 18. Jons C, Joergensen RM, Hassager C, Gang UJ, Dixen U, Johannesen A, et al. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy. Eur J Echocardiogr. 2010;11(7):602-7. 19. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89(2):724-30. 20. Balik M, Waldauf P, Maly M, Brozek T, Rulisek J, Porizka M, et al. Echocardiography predictors of sustained sinus rhythm after cardioversion of supraventricular arrhythmia in patients with septic shock. J Crit Care. 2024;83:154832. 21. Kirkpatrick JN, Panebianco N, Diaz-Gomez JL, Adhikari S, Bremer ML, Bronshteyn YS, et al. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. J Am Soc
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