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Wetterslev M, Møller MH, Granholm A, et al. Management of acute atrial fibrillation in the intensive care unit: an international survey. Acta Anaesthesiol Scand. 2021;doi: 10.1111/aas.14007.
Wetterslev, M., Møller, M. H., Granholm, A., Hassager, C., Haase, N., Naz Aslam, T., Shen, J., Young, P. J., Aneman, A., Hästbacka, J., Siegemund, M., Cronhjort, M., Lindqvist, E., Myatra, S. N., Kalvit, K., Arabi, Y. M., Szczeklik, W., Sigurdsson, M. I., Balik, M., Keus, F., Perner, A. (2021). Management of acute atrial fibrillation in the intensive care unit: an international survey. Acta anaesthesiologica Scandinavica, . https://doi.org/10.1111/aas.14007
Wetterslev, Mik, et al. "Management of acute atrial fibrillation in the intensive care unit: an international survey." Acta anaesthesiologica Scandinavica vol. (2021). doi: https://doi.org/10.1111/aas.14007
Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Naz Aslam T, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A. Management of acute atrial fibrillation in the intensive care unit: an international survey. Acta Anaesthesiol Scand. 2021 Dec 06; doi: 10.1111/aas.14007. Epub 2021 Dec 06. PMID: 34870855.
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Acta Anaesthesiol Scand. 2021 Dec 06; doi: 10.1111/aas.14007. Epub 2021 Dec 06.

Management of acute atrial fibrillation in the intensive care unit: an international survey.

Acta anaesthesiologica Scandinavica

Mik Wetterslev, Morten Hylander Møller, Anders Granholm, Christian Hassager, Nicolai Haase, Tayyba Naz Aslam, Jiawei Shen, Paul J Young, Anders Aneman, Johanna Hästbacka, Martin Siegemund, Maria Cronhjort, Elin Lindqvist, Sheila N Myatra, Kushal Kalvit, Yaseen M Arabi, Wojciech Szczeklik, Martin I Sigurdsson, Martin Balik, Frederik Keus, Anders Perner,

Affiliations

  1. Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  3. Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
  4. Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
  5. Intensive Care Specialist and co-Director, Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
  6. Intensive Care Programme Director, Medical Research Institute of New Zealand, Wellington, New Zealand.
  7. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  8. Department of Intensive Care Medicine, Liverpool Hospital, South Western Sydney Local Health District and South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
  9. Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  10. Department of Intensive Care Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
  11. Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
  12. Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
  13. Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  14. Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
  15. Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.
  16. Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
  17. Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic.
  18. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

PMID: 34870855 DOI: 10.1111/aas.14007

Abstract

BACKGROUND: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients.

METHOD: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy.

RESULTS: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with24 to 100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first line strategy for management of haemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For haemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants.

CONCLUSION: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.

This article is protected by copyright. All rights reserved.

Keywords: Anticoagulant therapy; Atrial fibrillation; Intensive care unit; Management strategies

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