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Funding Acknowledgements Type of funding sources: None. Background New-onset Atrial Fibrillation (neoAF) is a common complication in patients with sepsis and septic shock, imposing major challenges in management and worse prognosis; however, the actual prevalence of neoAF, as well as its impact on outcomes are still unclear. The aim of this study is to provide a comprehensive systematic review and meta-analysis on the prevalence of neoAF in patients with sepsis, and its impact on in-hospital mortality and intensive care unit (ICU) mortality. Methods Pubmed and EMBASE were systematically searched through 23th December 2020. Studies reporting on prevalence of neoAF and/or impact on in-hospital mortality or ICU mortality in patients with sepsis or septic shock were selected and included. Pooled prevalence and 95% Confidence Intervals (CI) were calculated, as well as Odds Ratios (OR), 95%CI and 95% Prediction Intervals (PI) for outcomes. Subgroup analysis and meta-regressions were performed to account for potential sources of heterogeneity; sensitivity analysis according to the "leave-one-out" approach were also performed. Results Among 4249 records retrieved from the literature search, 21 articles were identified and included in the systematic review. Across 207599 patients with sepsis or septic shock, prevalence of neoAF was found as high as 14% (95%CI: 9%-21%), with high heterogeneity between studies; significant subgroup differences were observed according to geographical location (with lower prevalences reported in North-American studies compared to European/Middle-East and Asian cohorts), study design and number of sepsis patients included in the original studies. A multivariate meta-regression model including sample size and geographical location was able to explain most part of the heterogeneity. Patients with sepsis showed an increased risk of both in-hospital mortality (OR: 2.31, 95%CI: 1.92-2.79, 95%PI: 1.52-3.53, Figure 1 panel A) and ICU mortality (OR: 2.66, 95%CI: 2.21-3.21, 95%PI: 1.77-4.00, Figure 1 panel B), with low to no heterogeneity detected between studies included. The "leave-one-out" sensitivity analysis confirmed the results of the main analysis. Conclusions Among patients with sepsis, neoAF is a common complication, being present in 1 out of 7 individuals. Patients with neoAF are at higher risk of mortality during sepsis, and may need specific therapeutical interventions. Abstract Figure.

Prevalence of new onset atrial fibrillation and associated outcomes in patients with sepsis: a systematic review and meta-analysis