BACKGROUND New onset atrial fibrillation is the most commonly encountered arrhythmia in critically unwell patients with a reported incidence of 4% to 29%. The occurrence of new onset atrial fibrillation may precipitate acute heart failure and lead to thromboembolic complications as well as being associated with increased in-hospital and in intensive care unit (ICU) mortality. Despite being common, much of our current knowledge regarding the treatment of new onset atrial fibrillation comes from patients with chronic atrial fibrillation or post cardiac surgery. It is unclear if management strategies in these patient cohorts can be applied to new onset atrial fibrillation in the general ICU. This protocol for a systematic review and network meta-analysis aims to address this uncertainty and define what is the most effective management strategy for the treatment of new onset atrial fibrillation (NOAF) in acutely unwell adult patients. METHODS In this systematic review and network meta-analysis, we plan to search electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and relevant trial registries) for relevant randomised and non-randomised trials. Citations will be reviewed by title, abstract and full text by two independent reviewers and disagreement resolved by discussion and a third independent reviewer, if necessary. The Cochrane Risk of Bias tool will be used to assess risk of bias in randomised trials and the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tool will be used for non-randomised studies. Statistical analysis will be carried out using R package meta and netmeta. We will first conduct a pairwise meta-analysis. If conditions for indirect comparison are satisfied and suitable data are available, we will conduct network meta-analysis using frequentist methodology. Treatments will be ranked according to efficacy with associated P-scores. We will assess the quality of the evidence in the pairwise using GRADE methodology and network meta-analysis comparisons in the CINeMA module in R package meta. DISCUSSION Our review will be the first to assess direct and indirect evidence to assess the efficacy and rank the treatments available for new onset atrial fibrillation in critically unwell patients. Our review findings will be applicable to the care of people in a range of acute settings including, ICU, the emergency department and acute medical units. SYSTEMATIC REVIEW REGISTRATION PROSPERO registry number: CRD42019121739.

中文翻译：

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对病情危重的成年患者新发心房颤动的治疗进行系统评价和网络荟萃分析的方案。


背景新发房颤是病情危重患者中最常见的心律失常，据报告发生率为 4% 至 29%。新发房颤的发生可能会引发急性心力衰竭并导致血栓栓塞并发症，并与院内和重症监护病房 (ICU) 死亡率增加相关。尽管很常见，但我们目前关于新发房颤治疗的大部分知识都来自慢性房颤或心脏手术后的患者。目前尚不清楚这些患者群体的管理策略是否可以应用于普通 ICU 中新发的房颤。本系统评价和网络荟萃分析方案旨在解决这种不确定性，并确定治疗急性不适成年患者新发心房颤动 (NOAF) 的最有效管理策略。方法 在本次系统评价和网络荟萃分析中，我们计划搜索电子数据库（Cochrane 对照试验中央注册库 [CENTRAL]、MEDLINE、EMBASE、Web of Science 上扩展的科学引文索引和相关试验注册库）以查找相关的随机和非-随机试验。引文将由两名独立审稿人按标题、摘要和全文进行审阅，如有必要，将通过讨论和第三名独立审稿人解决分歧。 Cochrane 偏倚风险工具将用于评估随机试验中的偏倚风险，非随机干预研究中的偏倚风险 (ROBINS-I) 工具将用于非随机研究。将使用R包meta和netmeta进行统计分析。我们将首先进行成对荟萃分析。 如果满足间接比较的条件并且有合适的数据，我们将使用频率主义方法进行网络荟萃分析。将根据疗效和相关 P 分数对治疗进行排名。我们将使用 R 包元中 CINeMA 模块中的 GRADE 方法和网络元分析比较来评估成对证据的质量。讨论 我们的综述将首次评估直接和间接证据，以评估疗效并对危重患者新发心房颤动可用的治疗方法进行排名。我们的审查结果将适用于各种急症环境中的人员护理，包括 ICU、急诊科和急症医疗单位。系统审查注册 PROSPERO 注册号：CRD42019121739。