Treatment strategies of new onset atrial fibrillation in patients treated in an intensive care unit: a literature review

Ieva Montvilaitė1

1Vilniaus Universitetas, Medicinos fakultetas, Vilnius, Lithuania


Background. In critically ill patients the probability of developing atrial fibrillation is 5%, and in patients with severe sepsis, it is as high as 50 %. Evidence suggests that new-onset atrial fibrillation is associated with higher mortality in critically ill patients admitted to the intensive care unit.

Aim. To review new-onset atrial fibrillation treatment tactics for patients treated in the intensive care unit.

Material and methods. Research was conducted in the PubMed database. Articles in English published between 2012 and 2022 were reviewed.

Results. Evidence on the optimal treatment strategy is limited and of low quality. It is unclear whether new-onset atrial fibrillation is a transient phenomenon during critical illness, and whether treatment of new-onset atrial fibrillation improves outcome. Rate control could be the best choice of treatment in critically ill patients, as spontaneous cardioversion is highly likely after the critical illness phase. Magnesium sulfate can be effective in both rhythm and rate control. Amiodarone is commonly used to restore sinus rhythm.

Conclusions. The most commonly used drug groups for rate control are beta-adrenoblockers and calcium channel blockers. Rhythm control is best achieved with magnesium sulfate and amiodarone infusions. Electrical cardioversion should be used in patients with atrial fibrillation and hemodynamic instability. Spontaneous cardioversion after the phase of critical illness is very likely. Unfractionated heparin is usually prescribed for the prevention of thromboembolism in the intensive care unit.

Keyword: new onset; atrial fibrillation; intensive care unit; critically ill.

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