Prospective, randomized, open-label clinical trial studying the treatment of new onset atrial fibrillation in critically ill patients with septic shock. Patients will be assigned to rhythm vs rate control strategies with various outcome measures assessed.

Data have demonstrated that critically ill patients with septic shock who develop atrial fibrillation suffer a greater likelihood of death and other complications when compared with patients who remain in sinus rhythm, however, little evidence exists to inform treatment strategies in this population. Ours is a pilot study evaluating rhythm vs rate control strategies in patients with septic shock and respiratory failure requiring invasive mechanical ventilation who develop new onset atrial fibrillation (NOAF). Design will be prospective, randomized, open-label. Patients in the rhythm control arm will receive IV amiodarone infusion followed by attempt at electrical cardioversion within 24 hours development of NOAF. Those in the rate control arm will receive negative chronotropic agents (beta blockers, calcium channel blockers, amiodarone, or digoxin) at the discretion of the treating physician. Available patient data will be collected for a total of 180 days following enrollment, and outcomes assessed will include ICU length of stay, ventilator free days, and time on vasopressors

Inclusion Criteria:

• No history of atrial fibrillation
• Meet Sepsis-3 criteria
• New onset atrial fibrillation in the ICU
• Atrial fibrillation treatment warranted
• Anticoagulation therapy not contraindicated
• On a ventilator
• Patient or family member willing to provide informed consent to participate in study

Exclusion Criteria:

• Post-cardiac or thoracic surgery
• Hemodynamically unstable
• Unable to tolerate anticoagulation
• Physician provider does not agree for patient to participate in study
• Patient or family member unwilling or unable to provide informed consent
• Expected death within 24 hours
• Non-English speakers