Provides a framework for managing atrial fibrillation in the ICU, highlighting diltiazem for rate control and procainamide or amiodarone for rhythm control in hemodynamically stable patients.
Provides a practical framework for ICU AF management; leaves open the need for dedicated RCTs to confirm preferences.
Atrial tachyarrhythmias are the most frequent arrhythmias occurring in ICU patients, being particularly common in patients with cardiovascular and respiratory failure. Unlike ambulatory patients in whom atrial fibrillation/flutter (AF) is likely to be short lived, in the critically ill these arrhythmias are unlikely to resolve until the underlying disease process has improved. Urgent cardioversion is indicated for hemodynamic instability. Treatment in hemodynamically stable patients includes correction of treatable precipitating factors, control of the ventricular response rate, conversion to sinus rhythm, and prophylaxis against thromboembolic events in those patients who remain in AF. Diltiazem is the preferred agent for rate control, while procainamide and amiodarone are generally considered to be the antiarrhythmic agents of choice.
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Marik et al. (2000) studied this question.
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