title: [Treatment of atrial fibrillation in intensive care units and emergency departments].
abstract: BACKGROUND
  Atrial fibrillation is the most common arrhythmia in patients hospitalized in intensive care units and emergency departments and is associated with an increased morbidity and mortality. In critically ill patients, atrial fibrillation can cause hemodynamic instability and cardiogenic shock. The mechanisms and the management of atrial fibrillation are significantly different in critically ill patients compared to outpatients.
  
  
  METHODS
  The initial management includes the evaluation of the hemodynamic consequences of new-onset atrial fibrillation and the optimization of reversible causes. In patients with hemodynamic instability the rapid restoration of an adequate perfusion pressure is the initial goal. Often, a rapid conversion in sinus rhythm is required to achieve hemodynamic stabilization. Electrical cardioversion, if possible performed after pretreatment with an antiarrhythmic drug to increase the success rate, frequently plays a central role in the conversion to sinus rhythm of hemodynamically unstable patients. Stable patients are initially treated with a short-acting intravenous β-blocker to achieve heart rate control. A conversion to sinus rhythm may be achieved pharmacologically with vernakalant, an atrial-specific multichannel blocker.
  
  
  RESULTS
  All patients with atrial fibrillation lasting more than 48 h should be evaluated for anticoagulation in order to reduce cardio-embolic complications. After recovering from the acute illness, atrial fibrillation persists only in a minority of patients.
authors: Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Raemistrasse 100, 8091, Zürich, Schweiz.|Herzchirurgische Intensivstation, Institut für Anästhesiologie, Universitätsspital Zürich, Raemistrasse 100, 8091, Zürich, Schweiz.
authors: M
authors: M
authors: Arrigo
authors: Herzchirurgische Intensivstation, Institut für Anästhesiologie, Universitätsspital Zürich, Raemistrasse 100, 8091, Zürich, Schweiz.
authors: D
authors: D
authors: Bettex
authors: Herzchirurgische Intensivstation, Institut für Anästhesiologie, Universitätsspital Zürich, Raemistrasse 100, 8091, Zürich, Schweiz. alain.rudiger@usz.ch.
authors: A
authors: A
authors: Rudiger
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000840:Anisoles / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D016638:Critical Illness; D004554:Electric Countershock; D004562:Electrocardiography / Q000187:drug effects; D004636:Emergency Service, Hospital; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D011412:Propanolamines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D011412:Propanolamines; D011759:Pyrrolidines; C524581:vernakalant; C036604:esmolol
keywords: Cardioversion; Critically ill; Esmolol; Intensive care unit; Vernakalant