The management of atrial fibrillation in the ICU

Atrial tachyarrhythmias are the most frequent arrhythmias occurring in ICU patients, being particularly common in patients with cardiovascular and res pirator) failure. Unlike ambulatory patients in whom atrial fibrillation/fl utter (AF) is likely to be short lived, in the critically ill these arrhyth mias are unlikely to resolve until the underlying disease process has impro ved. Urgent cardioversion is indicated for hemodynamic instability. Treatme nt in hemodynamically stable patients includes correction of treatable prec ipitating factors, control of the ventricular response rate, conversion to sinus rhythm, and prophylaxis against thromboembolic events in those patien ts who remain in AF, Diltiazem is the preferred agent for rate control, whi le procainamide and amiodarone are generally considered to be the antiarrhy thmic agents of choice.