Treatment of atrial fibrillation in ICU (apart from anticoagulation)

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in acutely ill patients. AF is partly triggered by non-cardiac factors such as hypoxia, sepsis, inflammation or ionic abnormalities. AF can lead to haemodynamic instability and thromboembolism, although its impact on mortality has not been clearly determined. AF management includes two distinct strategies based on heart rate and rhythm control. Data are too scarce to determine the most appropriate one in the critical care setting. Apart from direct current cardioversion, class III (and Ic) antiarrhythmics are commonly used to reverse AF to sinus rhythm; however, only few data are available on their usefulness and reliability in critically ill patients. In recent years, new agents with fewer proarrhythmic effects have been developed, but data are still lacking to recommend their use. Betablockers, calcium blockers, digoxin, and amiodarone may be used to control heart rate. The aim of this article is to provide an overview of the therapeutics used for AF cardioversion and rate control in the critical care setting.