DIAGNOSIS AND MANAGEMENT OF ATRIAL FIBRILLATION IN THE INTENSIVE CARE UNIT: WHERE ARE WE?

Abstract

The management of atrial fibrillation (AF) in the Intensive Care Unit (ICU) presents significant clinical challenges, necessitating a strategic approach tailored to the critical condition of patients. The decision between rate control, often achieved through beta-blockers or calcium channel blockers, and rhythm control, which may involve cardioversion and antiarrhythmic agents such as amiodarone, is central to therapeutic planning. Additionally, anticoagulation therapy remains a cornerstone in preventing thromboembolic complications, yet its application is complicated by the heightened risk of bleeding in critically ill patients. The variability in clinical practices across ICUs underscores the need for more consistent and evidence-based guidelines. The introduction of newer pharmacological agents, such as the highly cardio-selective beta-blocker landiolol, offers promising alternatives, though their use is still being evaluated in critical care settings. The complexities and controversies surrounding the optimal management of AF in the ICU highlight the necessity for ongoing research to refine therapeutic approaches, improve patient outcomes, and develop standardized treatment protocols that can be broadly applied in diverse clinical scenarios.