Rational management of atrial fibrillation in intensive care

Atrial fibrillation (AF) occurs frequently in intensive care unit (ICU) patients and after coronary bypass graft (CABG) and valve surgery, with the peak incidence on postoperative days 2 and 3. Moreover, AF is one of the most common complications after thoracic surgery, e.g. video-assisted thoracic surgery (VATS), lobectomy or extrapleural pneumonectomy. Prophylaxis with beta-blockers can reduce postoperative incidence of AF. The acute treatment of new-onset AF involves rhythm and frequency control and depends on whether the patient is hemodynamically stable or not. Rate control can be performed with beta-blockers or calcium-channel-blockers. Amiodarone is an effective and safe drug for converting AF to sinus rhythm. Conversion of AF should not be attempted 48 h after onset without anticoagulation or transesophageal echocardiography to rule out intracardiac thrombus formation. In order to avoid thromboembolism after cardioversion, an effective anticoagulation is mandatory.