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While \u03b2-adrenergic receptor blockers may mitigate this pathophysiology through sympatholytic and rate-controlling mechanisms, their association with patient survival remains incompletely characterized due to heterogeneous evidence. To elucidate the association between the administration of anti-catecholaminergic antiarrhythmic drugs and all-cause mortality in critically ill patients with sepsis-induced NOAF.This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care-IV database. We included adult patients admitted to a tertiary academic medical center between 2008 and 2019 who fulfilled the Sepsis-3 criteria and developed NOAF during their ICU stays.Based on the initial antiarrhythmic drug administration within 24\u00a0h following time-zero, patients were categorized into either \u03b2-blocker group or alternative antiarrhythmic drug group. The matched cohort comprised 560 patients (mean age 74.1 [SD 11.5] years; 64.6% male), among whom 280 were assigned to the \u03b2-blocker group and 280 to the alternative antiarrhythmic drug group. The \u03b2-blocker group demonstrated significantly lower 28-day mortality (36.1 vs. 51.1%; adjusted HR, 0.53; 95% CI, 0.41\u20130.67;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001) and 1-year mortality (50.7 vs. 63.6%; adjusted HR, 0.68; 95% CI, 0.55\u20130.85;\n                    <jats:italic>P<\/jats:italic>\n                    = .001). ICU mortality was also reduced in the \u03b2-blocker group (22.1 vs. 42.5%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). Furthermore, this group had more vasopressor-free days (median [IQR], 24.0 [18.0\u201326.0] vs. 16.0 [0.0\u201323.0]) and ventilator-free days (24.0 [18.0\u201326.0] vs. 17.0 [0.0\u201324.0]) (both\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). Safety outcomes included less bradycardia (12.5 vs. 20.0%;\n                    <jats:italic>P<\/jats:italic>\n                    = .016) but more hypotension (26.4 vs. 18.6%;\n                    <jats:italic>P<\/jats:italic>\n                    = .039). Subgroup and mediation analyses suggested greater benefit in high-risk patients, partially mediated (15.92%) by reduced vasopressor requirements. In critically ill patients with sepsis-induced NOAF, early \u03b2-blocker therapy was associated with markedly lower 28-day and 1-year mortality, along with decreased organ-support burden, warranting prospective trials are warranted to confirm these survival benefits.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-51249-9","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:10:12Z","timestamp":1783296612000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of anti-catecholaminergic antiarrhythmic drugs with survival in sepsis-associated new-onset atrial fibrillation"],"prefix":"10.1038","volume":"16","author":[{"given":"Xinyi","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayi","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zetong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang-Yin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"10219","key":"51249_CR1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","volume":"395","author":"KE Rudd","year":"2020","unstructured":"Rudd, K. 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