The Management of Atrial Fibrillation in the ICU
Article first published online: 28 JUN 2008
Journal of Intensive Care Medicine
Volume 15, Issue 4, pages 181–190, July/August 2000
How to Cite
Marik, P. E. and Zaloga, G. P. (2000), The Management of Atrial Fibrillation in the ICU. Journal of Intensive Care Medicine, 15: 181–190. doi: 10.1046/j.1525-1489.2000.00181.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Received Nov 29, 1999, and in revised form Jan 31, 2000. Accepted for publication Feb 4, 2000.
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.